Provider Demographics
NPI:1386814523
Name:BENTLEY, BRENDA LEE (CC HT, NLP, MBA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:CC HT, NLP, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 CORRALES RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9348
Mailing Address - Country:US
Mailing Address - Phone:505-899-9333
Mailing Address - Fax:
Practice Address - Street 1:3949 CORRALES RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9348
Practice Address - Country:US
Practice Address - Phone:505-899-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACHT 305-180305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service