Provider Demographics
NPI:1154626802
Name:BIERBAUM, JUDY (LPCC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:BIERBAUM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SAN PEDRO DR NE
Mailing Address - Street 2:SUITE 201-B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6744
Mailing Address - Country:US
Mailing Address - Phone:505-260-9912
Mailing Address - Fax:
Practice Address - Street 1:1330 SAN PEDRO DR NE
Practice Address - Street 2:SUITE 201-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6744
Practice Address - Country:US
Practice Address - Phone:505-260-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional