Healthcare Provider Details

I. General information

NPI: 1376758375
Provider Name (Legal Business Name): AMANDA N BROWN MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DON PASQUAL RD NW
LOS LUNAS NM
87031-8841
US

IV. Provider business mailing address

145 DON PASQUAL RD NW
LOS LUNAS NM
87031-8841
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-8654
  • Fax:
Mailing address:
  • Phone: 505-865-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0185801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: