Provider Demographics
NPI:1528599347
Name:BRISSO, RAYEANN MARIE (LMSW, LMAC)
Entity Type:Individual
Prefix:MRS
First Name:RAYEANN
Middle Name:MARIE
Last Name:BRISSO
Suffix:
Gender:F
Credentials:LMSW, LMAC
Other - Prefix:MS
Other - First Name:RAYEANN
Other - Middle Name:MARIE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW, LMAC
Mailing Address - Street 1:617 EAST ELM STREET
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-825-6224
Mailing Address - Fax:785-825-7595
Practice Address - Street 1:617 EAST ELM STREET
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-825-6224
Practice Address - Fax:785-825-7595
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10075104100000X
KS215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker