Organization
AMY BRASHEAR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY TERRELL BRASHEAR MC, M. DIV. (OWNER)
(505) 850-9419
Entity
Organization
Contact information
Practice address
12805 MENAUL BLVD NE, ALBUQUERQUE, NM 87112-2547
(505) 850-9419
Mailing address
12404 TULAROSA TRL NE, ALBUQUERQUE, NM 87111-7275
(505) 850-9419
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0095411
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19973748
—
NM
Enumeration date
07/17/2012
Last updated
07/17/2012
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