Provider Demographics
NPI:1801399795
Name:BRETT NELSON COUNSELING SERVICES
Entity Type:Organization
Organization Name:BRETT NELSON COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR-PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CMHC, NCC, CCTP
Authorized Official - Phone:505-275-1155
Mailing Address - Street 1:11927 MENAUL BLVD NE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2457
Mailing Address - Country:US
Mailing Address - Phone:505-275-1155
Mailing Address - Fax:505-275-1156
Practice Address - Street 1:11927 MENAUL BLVD NE STE 101
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2457
Practice Address - Country:US
Practice Address - Phone:505-275-1155
Practice Address - Fax:505-275-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ7299Medicaid