Healthcare Provider Details

I. General information

NPI: 1861032765
Provider Name (Legal Business Name): BRYCE DEVIN DOWNEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 LOS ARBOLES AVE NE
ALBUQUERQUE NM
87107-1943
US

IV. Provider business mailing address

9214 OSUNA PL NE
ALBUQUERQUE NM
87111-2275
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTL0209211
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: