Provider Demographics
NPI:1013316728
Name:BENAVIDEZ, RENEE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAN MATEO LN NE APT 202
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2401
Mailing Address - Country:US
Mailing Address - Phone:505-506-7234
Mailing Address - Fax:
Practice Address - Street 1:4050 EDITH BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2222
Practice Address - Country:US
Practice Address - Phone:505-383-3829
Practice Address - Fax:505-383-3802
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0157051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health