Provider Demographics
NPI:1831496769
Name:HANCOCK, BETH ELLEN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:BETH ELLEN
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 MENAUL BLVD NE STE 224A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2465
Mailing Address - Country:US
Mailing Address - Phone:505-321-7831
Mailing Address - Fax:866-311-6623
Practice Address - Street 1:11930 MENAUL BLVD NE STE 224A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2465
Practice Address - Country:US
Practice Address - Phone:505-321-7831
Practice Address - Fax:866-311-6623
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0137511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health