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General NPI Number Information
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NPI Number | 1508600487
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Entity Type | Individual
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Provider Name | BRYAN BEARY CIT
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Gender | Male
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Dates
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Enumeration Date | 06/24/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 4150 EARHART BLVD
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City | NEW ORLEANS
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State | LA
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Zip | 70125-1955
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Country | US
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Telephone | 504-821-7289
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Fax |
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Provider Business Mailing Address
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Address Line | 1336 ARIS AVE
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City | METAIRIE
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State | LA
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Zip | 70005-1714
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Country | US
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Telephone | 504-377-7975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CIT-5840
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | OBHPSS906
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License Number State | LA
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