Provider Demographics
NPI:1114698420
Name:VANESSA BRAUGHT COUNSELING, LLC
Entity Type:Organization
Organization Name:VANESSA BRAUGHT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-219-1973
Mailing Address - Street 1:317 VALLE ALTO DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4559
Mailing Address - Country:US
Mailing Address - Phone:505-514-9532
Mailing Address - Fax:
Practice Address - Street 1:4111 BARBARA LOOP SE STE E1
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1068
Practice Address - Country:US
Practice Address - Phone:505-219-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCCMH0211901OtherNEW MEXICO REGULATION AND LICENSING DEPARTMENT