Reynette Beynon, LPCC

Key facts

NPI

1669018024

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

License

CTB20240197 (NM)

Practice address

5916 Anaheim Ave NE Ste a
Albuquerque, NM 87113-1894

Phone

(505) 291-6314

NPI assigned

Nov 20, 2019

Sex

Female

Sole proprietor

No

Organizations & group practices 2

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

• Age to Age Counseling PC Counselor · Albuquerque, NM · NPI 1336178060
  Medicare reassignment NPD MENTAL HEALTH · NM
• Calico Therapy and Supervision, LLC Mental Health Counselor · Albuquerque, NM · NPI 1912832205
  NPD Authorized official MENTAL HEALTH

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 20, 2024.

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1669018024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5916 ANAHEIM AVE NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5916 ANAHEIM AVE NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131894",
            "telephone_number": "505-291-6314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEYNON",
        "first_name": "REYNETTE",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CMH0212411",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "CTB20240197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36075035",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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