Provider Demographics
NPI:1952297772
Name:BRUE, ADAM JACOB (LSAA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JACOB
Last Name:BRUE
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 CAMINO PLATA LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5826
Mailing Address - Country:US
Mailing Address - Phone:505-364-6908
Mailing Address - Fax:
Practice Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5859
Practice Address - Country:US
Practice Address - Phone:505-270-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2025-0401101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)