Provider Demographics
NPI:1629166301
Name:BENTZEN DAVIES, BEVERLY JEANNE (LPCC LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEANNE
Last Name:BENTZEN DAVIES
Suffix:
Gender:F
Credentials:LPCC LMFT
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC LMFT
Mailing Address - Street 1:8600 ACADEMY RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1107
Mailing Address - Country:US
Mailing Address - Phone:505-821-3628
Mailing Address - Fax:505-856-7103
Practice Address - Street 1:8600 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1107
Practice Address - Country:US
Practice Address - Phone:505-821-3628
Practice Address - Fax:508-856-7103
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMF2814106H00000X
NMCCMH0868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist