Healthcare Provider Details

I. General information

NPI: 1023484953
Provider Name (Legal Business Name): BETH ARMSTEAD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 W HIGHWAY 66
GRANTS NM
87020-9626
US

IV. Provider business mailing address

PO BOX 102
SAN RAFAEL NM
87051-0102
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-5451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4476
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: