Individual
STEPHANIE J BENALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1615 OJO COURT, FARMINGTON, NM 87401
(505) 564-4804
Mailing address
PO BOX 5190, FARMINGTON, NM 87499-5190
(505) 564-4804
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
122540481
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122540481
NEW MEXICO DRIVER LICENSE
NM
Enumeration date
04/10/2012
Last updated
04/10/2012
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