Healthcare Provider Details

I. General information

NPI: 1184065708
Provider Name (Legal Business Name): BEVERLY TENORIO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 CLOUDCROFT CIR
LAS CRUCES NM
88011-5230
US

IV. Provider business mailing address

2832 CLOUDCROFT CIRCLE
LAS CRUCES NM
88001-4701
US

V. Phone/Fax

Practice location:
  • Phone: 575-635-7171
  • Fax:
Mailing address:
  • Phone: 575-635-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0151631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: