Healthcare Provider Details

I. General information

NPI: 1871802660
Provider Name (Legal Business Name): BRENDA MOTLEY-LOPEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH ST
ALAMOGORDO NM
88310-5053
US

IV. Provider business mailing address

68A SIOUX TRL
TULAROSA NM
88352-9680
US

V. Phone/Fax

Practice location:
  • Phone: 575-488-2500
  • Fax:
Mailing address:
  • Phone: 575-430-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0900
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: