Provider Demographics
NPI:1902395924
Name:BRYCE RIESSLAND COUNSELING LLC
Entity Type:Organization
Organization Name:BRYCE RIESSLAND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:RIESSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-440-0948
Mailing Address - Street 1:32015 HAWK RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68866-3165
Mailing Address - Country:US
Mailing Address - Phone:308-440-0948
Mailing Address - Fax:308-388-5545
Practice Address - Street 1:124 W 46TH ST STE 105
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8348
Practice Address - Country:US
Practice Address - Phone:308-440-0948
Practice Address - Fax:308-388-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3527261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)