Provider Demographics
NPI:1134138845
Name:BRASHER, LESTER J JR (PHD, LPCC)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:J
Last Name:BRASHER
Suffix:JR
Gender:M
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 SAN MATEO BLVD NE
Mailing Address - Street 2:STE S-14
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-830-6500
Mailing Address - Fax:505-830-6527
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:STE S-14
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-830-6500
Practice Address - Fax:505-830-6527
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ4934Medicaid