Healthcare Provider Details

I. General information

NPI: 1154561447
Provider Name (Legal Business Name): MR. MATTHEW A. BIERDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BROADWAY BLVD NE
ALBUQUERQUE NM
87102-3431
US

IV. Provider business mailing address

1720 MOUNT HOOD TRL NW
ALBUQUERQUE NM
87120-4385
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-1068
  • Fax:
Mailing address:
  • Phone: 512-921-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2022-0953
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: