Provider Demographics
NPI:1467632240
Name:RIESSLAND, BRYCE D (LIMHP, LADC)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:D
Last Name:RIESSLAND
Suffix:
Gender:M
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 46TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8348
Mailing Address - Country:US
Mailing Address - Phone:308-440-5294
Mailing Address - Fax:888-325-2311
Practice Address - Street 1:124 W 46TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8348
Practice Address - Country:US
Practice Address - Phone:308-440-5294
Practice Address - Fax:888-325-2311
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELIMHP-1982101YM0800X
NELADC-711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)