MEDICARE: DR. BRIAN CHRISTOPHER PARTRIDGE PSY.D.

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	101YP2500X	Professional Counselor	62112	NM

General Provider Information

NPI Number	:	1639245913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN CHRISTOPHER PARTRIDGE PSY.D.

Provider Business Mailing Address
First Line	:	713 6TH ST
Second Line	:	OFFICE #2
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4359
Country	:	US
Telephone Number	:	505-425-2910
Fax Number	:	505-425-6236

Provider Business Practice Location Address
First Line	:	713 6TH ST
Second Line	:	OFFICE #2
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4359
Country	:	US
Telephone Number	:	505-425-2910
Fax Number	:	505-425-6236

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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