Healthcare Provider Details

I. General information

NPI: 1568070746
Provider Name (Legal Business Name): BRIAN MATTHEW GIRON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CARDENAS DR NE
ALBUQUERQUE NM
87108-1720
US

IV. Provider business mailing address

920 CARDENAS DR NE
ALBUQUERQUE NM
87108-1720
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-8168
  • Fax:
Mailing address:
  • Phone: 505-266-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0095841
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: