Basic Information
| Provider Information | |||||||||
| NPI: | 1164638821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 CAMINO DE LA TIERRA | ||||||||
| Address2: | |||||||||
| City: | CORRALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870488557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058986307 | ||||||||
| FaxNumber: | 5058986307 | ||||||||
| Practice Location | |||||||||
| Address1: | 1218 GRIEGOS RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871073752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053458471 | ||||||||
| FaxNumber: | 5053425450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 0097101 | NM | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.