Provider Demographics
NPI:1245443118
Name:PITTENGER, BRYCE ANNE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:BRYCE
Middle Name:ANNE
Last Name:PITTENGER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CENTRAL AVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3437
Mailing Address - Country:US
Mailing Address - Phone:505-321-0176
Mailing Address - Fax:505-265-3608
Practice Address - Street 1:315 CENTRAL AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3437
Practice Address - Country:US
Practice Address - Phone:505-321-0176
Practice Address - Fax:505-265-3608
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0078411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57326363Medicaid