Tina Lorraine Bezona, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4266 Issued in CO

Practice address

107 S 9TH St
Canon City, CO 81212-3800

Phone

(719) 430-5929

NPI assigned

Apr 14, 2007

Last updated

Jan 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sacred Self Counseling, LLC

  • Mental Health Counselor
  • Canon City, CO
  • NPI 1710614102
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1003031287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 S CAMINO SANTIAGO DR",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810071904",
            "telephone_number": "719-651-9301",
            "fax_number": "719-547-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S 9TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123800",
            "telephone_number": "719-430-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEZONA",
        "first_name": "TINA",
        "middle_name": "LORRAINE",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-14",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "4266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Bergant, MSW
• Patricia L Berndt, NP
• Demmi Berry
• Melanie Betts
• Jacob Beus, DMD
• Kellie Bird
• Robert Marvin Bischoff, PTA
• Ginger L Bivens, RN
• Blair Vision Care, LLC
• Nicholas Blair, O.D.

• Professional Counselor in Canon City, CO
• Providers in Canon City, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.