Provider Demographics
NPI:1013312552
Name:BRALEY, BRYAN JAMES
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:BRALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-2448
Mailing Address - Country:US
Mailing Address - Phone:402-340-3350
Mailing Address - Fax:
Practice Address - Street 1:1312 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2448
Practice Address - Country:US
Practice Address - Phone:402-340-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker