Provider Demographics
NPI:1245418169
Name:BREM, DORCAS FIELDSON (LPCC)
Entity Type:Individual
Prefix:MS
First Name:DORCAS
Middle Name:FIELDSON
Last Name:BREM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:DORCAS
Other - Middle Name:FIELDSON
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-2834
Mailing Address - Country:US
Mailing Address - Phone:575-937-7751
Mailing Address - Fax:
Practice Address - Street 1:318 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-2834
Practice Address - Country:US
Practice Address - Phone:575-937-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0109611101YM0800X
HI156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15025225Medicaid