Healthcare Provider Details

I. General information

NPI: 1265604961
Provider Name (Legal Business Name): BRYAN H VRALSTED LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CURTISS RD STE 100
BARKSDALE AFB LA
71110-2425
US

IV. Provider business mailing address

243 CURTISS RD STE 100
BARKSDALE AFB LA
71110-2425
US

V. Phone/Fax

Practice location:
  • Phone: 317-456-6791
  • Fax:
Mailing address:
  • Phone: 317-456-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-1027
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: