Healthcare Provider Details

I. General information

NPI: 1942641790
Provider Name (Legal Business Name): BETHANNE KEE LMSW/LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 RANCH CLUB RD
SILVER CITY NM
88061-7807
US

IV. Provider business mailing address

304 S RIDGE RD
SILVER CITY NM
88061-6610
US

V. Phone/Fax

Practice location:
  • Phone: 575-956-8862
  • Fax: 575-388-2457
Mailing address:
  • Phone: 575-956-8862
  • Fax: 575-388-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-08245
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: