Provider Demographics
NPI:1821233644
Name:BENALLI, DEBRA ANN (LPCC, LADAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:BENALLI
Suffix:
Gender:F
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:LANGFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, LADAC
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:JEMEZ PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87024
Mailing Address - Country:US
Mailing Address - Phone:575-834-3139
Mailing Address - Fax:575-834-9507
Practice Address - Street 1:110 SHEEP SPRINGS RD.
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87024
Practice Address - Country:US
Practice Address - Phone:575-834-3139
Practice Address - Fax:575-834-9507
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5705101YA0400X
NM83581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health