Healthcare Provider Details

I. General information

NPI: 1265243174
Provider Name (Legal Business Name): LANCE BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RIO RANCHO BLVD NE STE 200
RIO RANCHO NM
87124-1458
US

IV. Provider business mailing address

400 ROBERT CT NE
RIO RANCHO NM
87124-4814
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1460
  • Fax:
Mailing address:
  • Phone: 505-226-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: