Healthcare Provider Details

I. General information

NPI: 1831008713
Provider Name (Legal Business Name): BRYANNA MARIE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2887 S MARYLAND PKWY
LAS VEGAS NV
89109-1511
US

IV. Provider business mailing address

7735 LITTLE VALLEY AVE
LAS VEGAS NV
89147-4997
US

V. Phone/Fax

Practice location:
  • Phone: 702-474-4104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number08236-I
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: