Healthcare Provider Details

I. General information

NPI: 1376904896
Provider Name (Legal Business Name): BRANDY EASTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SHERWOOD ST NE
ALBUQUERQUE NM
87109-2764
US

IV. Provider business mailing address

4501 SHERWOOD ST NE
ALBUQUERQUE NM
87109-2764
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-7415
  • Fax:
Mailing address:
  • Phone: 505-550-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0173761
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: