Healthcare Provider Details

I. General information

NPI: 1124911771
Provider Name (Legal Business Name): BRENNAN BOWMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SILVER AVE SW STE 345
ALBUQUERQUE NM
87102-3111
US

IV. Provider business mailing address

7023 KAYSER MILL RD NW
ALBUQUERQUE NM
87114-5978
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-8435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0354
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: