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General NPI Number Information
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NPI Number | 1962738054
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Entity Type | Individual
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Provider Name | LIDIA ATENCIO
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Gender | Female
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 2503 RIDGE RUNNER RD
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City | LAS VEGAS
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State | NM
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Zip | 87701-4972
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Country | US
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Telephone | 505-454-8265
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Fax |
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Provider Business Mailing Address
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Address Line | 2551 COORS BLVD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1213
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Country | US
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Telephone |
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Fax | 505-820-9220
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | T-0126541
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0158221
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License Number State | NM
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