Healthcare Provider Details

I. General information

NPI: 1174242796
Provider Name (Legal Business Name): BRIAN BALDONADO LPCC, LADAC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 CAMPUS BLVD NE
ALBUQUERQUE NM
87106-1314
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-1289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: