Provider Demographics
NPI:1003031287
Name:BEZONA, TINA LORRAINE (LPC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:LORRAINE
Last Name:BEZONA
Suffix:
Gender:F
Credentials:LPC
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1183 S CAMINO SANTIAGO DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1904
Mailing Address - Country:US
Mailing Address - Phone:719-651-9301
Mailing Address - Fax:719-547-8171
Practice Address - Street 1:107 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3800
Practice Address - Country:US
Practice Address - Phone:719-430-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional