Basic Information
| Provider Information | |||||||||
| NPI: | 1003006131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENDER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4308 CARLISLE BLVD NE STE 209 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871074849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056811140 | ||||||||
| FaxNumber: | 5058887943 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 MAIN STREET | ||||||||
| Address2: | DELTA, CO 81416 | ||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814168141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056811140 | ||||||||
| FaxNumber: | 5058887943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 3377 | NM | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 3377 | 01 | NM | NEW MEXICO STATE COUNSELING LICENSE | OTHER |