Provider Demographics
NPI:1265604961
Name:VRALSTED, BRYAN H (LCSW)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:H
Last Name:VRALSTED
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ALDEN DR BLDG 160
Mailing Address - Street 2:
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005-2945
Mailing Address - Country:US
Mailing Address - Phone:307-773-3186
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DR BLDG 160
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82005-2945
Practice Address - Country:US
Practice Address - Phone:307-773-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-10271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical