Healthcare Provider Details

I. General information

NPI: 1407965163
Provider Name (Legal Business Name): BRETT ALAN NELSON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11927 MENAUL BLVD NE SUITE 101
ALBUQUERQUE NM
87112-1787
US

IV. Provider business mailing address

11927 MENAUL BLVD NE SUITE 101
ALBUQUERQUE NM
87112-1787
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-1155
  • Fax: 505-275-1156
Mailing address:
  • Phone: 505-275-1155
  • Fax: 505-275-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0954
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: