Provider Demographics
NPI:1972257855
Name:ERNESTINE TENNEFOS
Entity type:Organization
Organization Name:ERNESTINE TENNEFOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNEFOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-791-5507
Mailing Address - Street 1:930 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6635
Mailing Address - Country:US
Mailing Address - Phone:575-791-5507
Mailing Address - Fax:
Practice Address - Street 1:930 W 17TH ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6635
Practice Address - Country:US
Practice Address - Phone:575-791-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health