Provider Demographics
NPI:1386141893
Name:BREWER-VANDERLINDEN, LORI MICHELLE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:BREWER-VANDERLINDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 MONTE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3010
Mailing Address - Country:US
Mailing Address - Phone:940-867-6124
Mailing Address - Fax:
Practice Address - Street 1:5005 N. PIEDRAS STREET
Practice Address - Street 2:ATTN WBAMC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14262101YA0400X
TX19491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)