Provider Demographics
NPI:1992333579
Name:BRYAN, JULIE MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-6600
Mailing Address - Country:US
Mailing Address - Phone:575-740-5096
Mailing Address - Fax:
Practice Address - Street 1:900 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-6600
Practice Address - Country:US
Practice Address - Phone:575-297-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X
NM846175T00000X
NMCTB-2024-0308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist