Provider Demographics
NPI:1598221814
Name:LEE-HERBERT, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LEE-HERBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 CALLE ANGELINA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8457
Mailing Address - Country:US
Mailing Address - Phone:518-253-7697
Mailing Address - Fax:
Practice Address - Street 1:805 EARLY ST STE F-1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1607
Practice Address - Country:US
Practice Address - Phone:518-253-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0201821101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor