Provider Demographics
NPI:1740418169
Name:ONTIVEROS, BERNADETTE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:BERNADETTE
Middle Name:
Last Name:ONTIVEROS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 RIVERA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2415
Mailing Address - Country:US
Mailing Address - Phone:915-533-7057
Mailing Address - Fax:915-533-7158
Practice Address - Street 1:11710 PEBBLE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0802
Practice Address - Country:US
Practice Address - Phone:915-533-7057
Practice Address - Fax:905-533-7158
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0122331101YA0400X
TX75206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMVNM01103NIOtherVALUE OPTIONS