Provider Demographics
NPI:1427446186
Name:BENNETT, RHONDA LYNETTE (LPCC)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNETTE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:THOREAU
Mailing Address - State:NM
Mailing Address - Zip Code:87323-1017
Mailing Address - Country:US
Mailing Address - Phone:505-862-7417
Mailing Address - Fax:
Practice Address - Street 1:15 NAVARRE BLVD.
Practice Address - Street 2:
Practice Address - City:THOREAU
Practice Address - State:NM
Practice Address - Zip Code:87323-1017
Practice Address - Country:US
Practice Address - Phone:505-862-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0198691101YM0800X
103K00000X
NMCTB-2023-1043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst