Provider Demographics
NPI:1033459268
Name:BRANDON, REBEKAH JO (LMHC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JO
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 MIGUEL CHAVEZ RD UNIT 1423
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6956
Mailing Address - Country:US
Mailing Address - Phone:505-629-5853
Mailing Address - Fax:
Practice Address - Street 1:2019 GALISTEO ST STE D2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2169
Practice Address - Country:US
Practice Address - Phone:505-983-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0175001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health