Provider Demographics
NPI:1609976463
Name:BRYAN, DANNY (LISW)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:LISW
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 1914
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-1914
Mailing Address - Country:US
Mailing Address - Phone:505-441-4381
Mailing Address - Fax:
Practice Address - Street 1:1601 TURNER STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:505-441-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-30241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM600854Medicaid