Provider Demographics
NPI:1316270648
Name:BRYANT, CELINA GERESE (MSW, LSAA)
Entity type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:GERESE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSW, LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W TEXAS AVE
Mailing Address - Street 2:PO BOX 654
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1968
Mailing Address - Country:US
Mailing Address - Phone:575-736-3312
Mailing Address - Fax:575-748-7334
Practice Address - Street 1:811 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1968
Practice Address - Country:US
Practice Address - Phone:575-736-3312
Practice Address - Fax:575-748-7334
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0105921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health