Provider Demographics
NPI:1407965163
Name:NELSON, BRETT ALAN (LPCC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11927 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1787
Mailing Address - Country:US
Mailing Address - Phone:505-275-1155
Mailing Address - Fax:505-275-1156
Practice Address - Street 1:11927 MENAUL BLVD NE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1787
Practice Address - Country:US
Practice Address - Phone:505-275-1155
Practice Address - Fax:505-275-1156
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ7299Medicaid