Provider Demographics
NPI:1013240746
Name:SERNA, BRIAN (LPCC, LADAC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:SERNA
Suffix:
Gender:M
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 AVENIDA ALAMOSA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87022-0580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:505-869-4584
Practice Address - Street 1:2904 AVENIDA ALAMOSA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0454
Practice Address - Country:US
Practice Address - Phone:505-660-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0093101101YA0400X
NM0130451101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional