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NPI Code Detail

MEDICARE: DR. DENNIS MICHAEL BEAUFAIT ED D

MEDICARE:  DR. DENNIS MICHAEL BEAUFAIT  ED D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist005152MI
2103TC0700XClinical Psychologist2857CO
3103TC1900XCounseling Psychologist4114AZ

General Provider Information

NPI Number : 1538277058
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENNIS MICHAEL BEAUFAIT ED D
Provider Business Mailing Address
First Line : PO BOX 32390
Second Line :
City : SANTA FE
State : NM
Zip : 87594-2390
Country : US
Telephone Number : 888-982-3113
Fax Number :
Provider Business Practice Location Address
First Line : 119 E MARCY ST STE 202
Second Line :
City : SANTA FE
State : NM
Zip : 87501-2046
Country : US
Telephone Number : 888-982-3113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 10/24/2016

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Directions to “ DR. DENNIS MICHAEL BEAUFAIT ED D” Practice Location

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