Provider Demographics
NPI:1891362950
Name:JULIO BRIONEZ LLC
Entity Type:Organization
Organization Name:JULIO BRIONEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-352-9554
Mailing Address - Street 1:710 E GARFIELD ST STE 325
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3985
Mailing Address - Country:US
Mailing Address - Phone:307-352-9554
Mailing Address - Fax:
Practice Address - Street 1:710 E GARFIELD ST STE 325
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3985
Practice Address - Country:US
Practice Address - Phone:307-352-9554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty