Provider Demographics
NPI:1003823477
Name:BRYANT, ELIZABETH MERRIKEN (MS, LPCC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MERRIKEN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4913
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-4913
Mailing Address - Country:US
Mailing Address - Phone:505-937-4349
Mailing Address - Fax:505-257-3910
Practice Address - Street 1:1096 MECHEM DR
Practice Address - Street 2:SUITE 217
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7067
Practice Address - Country:US
Practice Address - Phone:505-937-4349
Practice Address - Fax:505-257-3910
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0066622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48803596Medicaid