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General NPI Number Information
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NPI Number | 1003031287
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Entity Type | Individual
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Provider Name | TINA LORRAINE BEZONA LPC
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Gender | Female
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 107 S 9TH ST
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City | CANON CITY
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State | CO
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Zip | 81212-3800
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Country | US
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Telephone | 719-430-5929
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Fax |
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Provider Business Mailing Address
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Address Line | 1183 S CAMINO SANTIAGO DR
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City | PUEBLO WEST
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State | CO
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Zip | 81007-1904
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Country | US
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Telephone | 719-651-9301
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Fax | 719-547-8171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4266
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License Number State | CO
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