Provider Demographics
NPI:1467632240
Name:RIESSLAND, BRYCE D (LMHP, LADC)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:D
Last Name:RIESSLAND
Suffix:
Gender:M
Credentials:LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 W FAIDLEY AVE
Mailing Address - Street 2:PO BOX 9804
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4645
Mailing Address - Country:US
Mailing Address - Phone:308-398-5427
Mailing Address - Fax:308-398-5404
Practice Address - Street 1:2116 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4645
Practice Address - Country:US
Practice Address - Phone:308-398-5427
Practice Address - Fax:308-398-5404
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEPLADC-426101YA0400X
NEPLMHP 7497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)