Provider Demographics
NPI:1902415417
Name:ACKLAND, BRANDY KATE (MED, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:KATE
Last Name:ACKLAND
Suffix:
Gender:F
Credentials:MED, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BLUEBIRD ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-2806
Mailing Address - Country:US
Mailing Address - Phone:406-461-1899
Mailing Address - Fax:
Practice Address - Street 1:1313 W MERMOD ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4468
Practice Address - Country:US
Practice Address - Phone:575-200-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0210061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health