Healthcare Provider Details

I. General information

NPI: 1801399795
Provider Name (Legal Business Name): BRETT NELSON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11927 MENAUL BLVD NE STE 101
ALBUQUERQUE NM
87112-2457
US

IV. Provider business mailing address

11927 MENAUL BLVD NE STE 101
ALBUQUERQUE NM
87112-2457
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: MRS. BRETT ALAN NELSON
Title or Position: OWNER/COUNSELOR-PSYCHOTHERAPIST
Credential: MA, CMHC, NCC, CCTP
Phone: 505-275-1155