Healthcare Provider Details

I. General information

NPI: 1376748517
Provider Name (Legal Business Name): BRENDA LYNN ALVARADO CLINICAL MENTAL HEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 EAST GRAND AVE. RIOVIDA COUNSELING
CLOVIS NM
88101
US

IV. Provider business mailing address

311 NORTH AVE. Q
PORTALES NM
88130
US

V. Phone/Fax

Practice location:
  • Phone: 505-762-9000
  • Fax: 505-762-9009
Mailing address:
  • Phone: 575-607-7822
  • Fax: 575-935-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0132781
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: