Provider Demographics
NPI:1497484901
Name:BROWN, BRENDA L (LSAA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ROAD 5575
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-1318
Mailing Address - Country:US
Mailing Address - Phone:505-444-0068
Mailing Address - Fax:
Practice Address - Street 1:60 ROAD 5575
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-1318
Practice Address - Country:US
Practice Address - Phone:505-444-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)