Provider Demographics
NPI:1477688679
Name:BRYANT, ELIZABETH (PHD,LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD,LMT
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 1024
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1024
Mailing Address - Country:US
Mailing Address - Phone:505-740-4224
Mailing Address - Fax:505-744-0078
Practice Address - Street 1:408 SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:ELEPHANT BUTTE
Practice Address - State:NM
Practice Address - Zip Code:87935
Practice Address - Country:US
Practice Address - Phone:505-740-4224
Practice Address - Fax:505-744-0078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2996174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist