Provider Demographics
NPI:1124324454
Name:BRANDT, JANE ANN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOLIDAY DR.
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7838
Mailing Address - Country:US
Mailing Address - Phone:505-239-3555
Mailing Address - Fax:
Practice Address - Street 1:21 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7838
Practice Address - Country:US
Practice Address - Phone:505-239-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor