MEDICARE: BRETT NELSON COUNSELING SERVICES

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	0954	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801399795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRETT NELSON COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	11927 MENAUL BLVD NE STE 101
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2457
Country	:	US
Telephone Number	:	505-275-1155
Fax Number	:	505-275-1156

Provider Business Practice Location Address
First Line	:	11927 MENAUL BLVD NE STE 101
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2457
Country	:	US
Telephone Number	:	505-275-1155
Fax Number	:	505-275-1156

Authorized Official
Title or Position	:	OWNER/COUNSELOR-PSYCHOTHERAPIST
Name	:	MRS. BRETT ALAN NELSON
Credential	:	MA, CMHC, NCC, CCTP
Telephone Number	:	505-275-1155

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	03/16/2018

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Directions to “BRETT NELSON COUNSELING SERVICES ” Practice Location

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