Provider Demographics
NPI:1629286810
Name:BRIZAL, KATHRYN ANNETTE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANNETTE
Last Name:BRIZAL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:ANNETTE
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3610 HAVASU FALLS ST NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-2549
Mailing Address - Country:US
Mailing Address - Phone:505-916-9091
Mailing Address - Fax:
Practice Address - Street 1:5608 ZUNNI RD. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-262-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC1591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ8794Medicaid
NMNM100112OtherVALUEOPTIONS NM
NM00R99ZOtherBCBSNM