Individual
JEANETTE D BRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
214 E MAIN ST, TUCUMCARI, NM 88401-2223
(505) 461-6080
(505) 461-4802
Mailing address
214 W BARNES AVE, TUCUMCARI, NM 88401-3271
(505) 461-6080
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1266
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89534077
—
NM
Enumeration date
10/03/2006
Last updated
07/08/2007
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