Healthcare Provider Details

I. General information

NPI: 1225894975
Provider Name (Legal Business Name): BRIAN BOLDING LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 OSUNA RD NE STE A102
ALBUQUERQUE NM
87109-2587
US

IV. Provider business mailing address

5801 OSUNA RD NE STE A102
ALBUQUERQUE NM
87109-2587
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-4769
  • Fax:
Mailing address:
  • Phone: 505-639-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: