MEDICARE: BERNADETTE PINA LPCC

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
1	101YP2500X	Professional Counselor	11475	TX
2	101YP2500X	Professional Counselor	2880	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639108244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE PINA LPCC

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	HATCH
State	:	NM
Zip	:	87937-0370
Country	:	US
Telephone Number	:	575-267-3280
Fax Number	:	575-267-1747

Provider Business Practice Location Address
First Line	:	1955 N VALLEY DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007
Country	:	US
Telephone Number	:	575-541-7323
Fax Number	:	575-527-9415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/12/2018

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