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General NPI Number Information
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NPI Number | 1750185716
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Entity Type | Organization
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Legal Business Name | BRIE BEDARD INTEGRATIVE WELLNESS
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 5941 MILLER RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-7771
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Country | US
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Telephone | 570-588-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 5941 MILLER RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-7771
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Country | US
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Telephone | 570-588-8555
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | BRIANNA ALLEN
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Credential | LPCC
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Telephone | 570-588-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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