Provider Demographics
NPI:1083334544
Name:BERMUDEZ, ANTONIO (LPC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BERMUDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:825 N FOURTH ST APT 32
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-8272
Mailing Address - Country:US
Mailing Address - Phone:915-442-3310
Mailing Address - Fax:
Practice Address - Street 1:825 N FOURTH ST APT 32
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-8272
Practice Address - Country:US
Practice Address - Phone:915-443-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health