Healthcare Provider Details

I. General information

NPI: 1104666361
Provider Name (Legal Business Name): ANDREA BRIANNE SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 EL PASEO RD STE B
LAS CRUCES NM
88001-6019
US

IV. Provider business mailing address

2540 EL PASEO RD STE B
LAS CRUCES NM
88001-6019
US

V. Phone/Fax

Practice location:
  • Phone: 575-243-5846
  • Fax:
Mailing address:
  • Phone: 575-243-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0014
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: