Provider Demographics
NPI:1003006131
Name:BENDER, THOMAS S (LPCC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:BENDER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 CARLISLE BLVD NE STE 209
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4849
Mailing Address - Country:US
Mailing Address - Phone:505-681-1140
Mailing Address - Fax:505-888-7943
Practice Address - Street 1:540 MAIN STREET
Practice Address - Street 2:DELTA, CO 81416
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-8141
Practice Address - Country:US
Practice Address - Phone:505-681-1140
Practice Address - Fax:505-888-7943
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3377101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3377OtherNEW MEXICO STATE COUNSELING LICENSE