Provider Demographics
NPI:1417417809
Name:CULLISON, BRYNDA JENA (MFT,NCC)
Entity Type:Individual
Prefix:
First Name:BRYNDA
Middle Name:JENA
Last Name:CULLISON
Suffix:
Gender:F
Credentials:MFT,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N GREEN VALLEY PKWY BLDG D
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0273
Mailing Address - Country:US
Mailing Address - Phone:702-605-2766
Mailing Address - Fax:702-938-9056
Practice Address - Street 1:2501 N GREEN VALLEY PKWY BLDG D
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0273
Practice Address - Country:US
Practice Address - Phone:702-605-2766
Practice Address - Fax:702-938-9056
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2591-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist