Healthcare Provider Details

I. General information

NPI: 1245443118
Provider Name (Legal Business Name): BRYCE ANNE PITTENGER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CENTRAL AVE NW SUITE A
ALBUQUERQUE NM
87102-3437
US

IV. Provider business mailing address

315 CENTRAL AVE NW SUITE A
ALBUQUERQUE NM
87102-3437
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-0176
  • Fax: 505-265-3608
Mailing address:
  • Phone: 505-321-0176
  • Fax: 505-265-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0078411
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: