MEDICARE: ANDREA BRIANNE SALAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	CTB-2025-0014	NM

General Provider Information

NPI Number	:	1104666361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BRIANNE SALAS

Provider Business Mailing Address
First Line	:	2540 EL PASEO RD STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-6019
Country	:	US
Telephone Number	:	575-243-5846
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 EL PASEO RD STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-6019
Country	:	US
Telephone Number	:	575-243-5846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	01/16/2025

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Directions to “ ANDREA BRIANNE SALAS ” Practice Location

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