MEDICARE: VANESSA BRAUGHT LPCC

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	101YM0800X	Mental Health Counselor	T-0191171	NM
2	101YP2500X	Professional Counselor	CCMH0211901	NM

General Provider Information

NPI Number	:	1578081311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA BRAUGHT LPCC

Provider Business Mailing Address
First Line	:	500 UNSER BLVD SE STE 103
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4660
Country	:	US
Telephone Number	:	505-404-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 UNSER BLVD SE STE 103
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4660
Country	:	US
Telephone Number	:	505-404-0554
Fax Number	:	505-393-4525

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

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	12/16/2020

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