Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 3377 | NM |
NPI | 1003006131 |
---|---|
Provider Name | Mr. Thomas S. Bender |
First Address | Albuquerque, NM 87107-4849 |
Second Address | Delta, CO 81416-8141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3377 | NEW MEXICO STATE COUNSELING LICENSE (01) | NM |