Healthcare Provider Details

I. General information

NPI: 1366502353
Provider Name (Legal Business Name): BRENDA S. JANZEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 ACADEMY RD NE
ALBUQUERQUE NM
87111-1107
US

IV. Provider business mailing address

8600 ACADEMY RD NE
ALBUQUERQUE NM
87111-1107
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-3628
  • Fax:
Mailing address:
  • Phone: 505-821-3628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number005850
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: