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General NPI Number Information
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NPI Number | 1871264580
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Entity Type | Organization
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Legal Business Name | ERNESTINE TENNEFOS
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 930 W 17TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6635
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Country | US
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Telephone | 575-791-5507
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Fax |
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Provider Business Mailing Address
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Address Line | 930 W 17TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6635
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Country | US
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Telephone | 575-791-5507
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICIAN
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Name | ERNESTINE TENNEFOS
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Credential | MA; LPCC
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Telephone | 575-579-5507
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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 |
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License Number State |
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