Provider Demographics
NPI:1265174726
Name:BROWNDOG COUNSELING, LLC
Entity type:Organization
Organization Name:BROWNDOG COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-S, LCSW
Authorized Official - Phone:505-394-8037
Mailing Address - Street 1:3708 BRYN MAWR DR NE APT C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4361
Mailing Address - Country:US
Mailing Address - Phone:505-394-8037
Mailing Address - Fax:
Practice Address - Street 1:3708 BRYN MAWR DR NE APT C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4361
Practice Address - Country:US
Practice Address - Phone:505-394-8037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty