Provider Demographics
NPI:1639245913
Name:PARTRIDGE, BRIAN CHRISTOPHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:PARTRIDGE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 6TH ST
Mailing Address - Street 2:OFFICE #2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4359
Mailing Address - Country:US
Mailing Address - Phone:505-425-2910
Mailing Address - Fax:505-425-6236
Practice Address - Street 1:713 6TH ST
Practice Address - Street 2:OFFICE #2
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4359
Practice Address - Country:US
Practice Address - Phone:505-425-2910
Practice Address - Fax:505-425-6236
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional