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General NPI Number Information
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NPI Number | 1417281775
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Entity Type | Individual
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Provider Name | KATHLEEN BENECKE
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Gender | Female
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 805 EARLY ST BLDG B STE 104 D
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City | SANTA FE
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State | NM
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Zip | 87505-6516
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Country | US
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Telephone | 505-660-5209
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Fax | 505-795-7638
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Provider Business Mailing Address
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Address Line | 2891 PLAZA BLANCA
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City | SANTA FE
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State | NM
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Zip | 87507-6516
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Country | US
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Telephone | 505-660-5209
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Fax | 505-795-7638
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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 | CCMH0080461
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License Number State | NM
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