Healthcare Provider Details

I. General information

NPI: 1427446186
Provider Name (Legal Business Name): RHONDA LYNETTE BENNETT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NAVARRE BLVD.
THOREAU NM
87323-1017
US

IV. Provider business mailing address

PO BOX 1017
THOREAU NM
87323-1017
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-7417
  • Fax:
Mailing address:
  • Phone: 505-862-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0198691
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-1043
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: