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General NPI Number Information
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NPI Number | 1720341753
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Entity Type | Organization
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Legal Business Name | ON-SITE CRISIS INTERVENTION LLC
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 851 GOMEZ RD
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City | EL PASO
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State | TX
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Zip | 79932-4205
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Country | US
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Telephone | 915-525-2796
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Fax | 915-581-6708
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Provider Business Mailing Address
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Address Line | 851 GOMEZ RD
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City | EL PASO
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State | TX
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Zip | 79932-4205
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Country | US
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Telephone | 915-525-2796
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Fax | 915-581-6708
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Authorized Official
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Title or Position | OWNER/CLINICAL COUNSELOR
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Name | DR. DIANE HARDWICK BRYAN
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Credential | PH.D.
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Telephone | 915-525-2796
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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 | 7697
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 62311
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License Number State | TX
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