Healthcare Provider Details

I. General information

NPI: 1750185716
Provider Name (Legal Business Name): BRIE BEDARD INTEGRATIVE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 MILLER RD NE
RIO RANCHO NM
87144-7771
US

IV. Provider business mailing address

5941 MILLER RD NE
RIO RANCHO NM
87144-7771
US

V. Phone/Fax

Practice location:
  • Phone: 570-588-8555
  • Fax:
Mailing address:
  • Phone: 570-588-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA ALLEN
Title or Position: OWNER/COUNSELOR
Credential: LPCC
Phone: 570-588-8555