Healthcare Provider Details

I. General information

NPI: 1265174726
Provider Name (Legal Business Name): BROWNDOG COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 BRYN MAWR DR NE APT C
ALBUQUERQUE NM
87107-4361
US

IV. Provider business mailing address

3708 BRYN MAWR DR NE APT C
ALBUQUERQUE NM
87107-4361
US

V. Phone/Fax

Practice location:
  • Phone: 505-394-8037
  • Fax:
Mailing address:
  • Phone: 505-394-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS SCOTT
Title or Position: THERAPIST
Credential: MSSA, LISW-S, LCSW
Phone: 505-394-8037