Provider Demographics
NPI:1932316932
Name:MIERA--MEDINA, BEATRICE OLIVIA (LPCC)
Entity type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:OLIVIA
Last Name:MIERA--MEDINA
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 28164
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8164
Mailing Address - Country:US
Mailing Address - Phone:505-216-2727
Mailing Address - Fax:
Practice Address - Street 1:920 SALAZAR RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-8224
Practice Address - Country:US
Practice Address - Phone:575-751-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174400000XOther Service ProvidersSpecialist