Basic Information
| Provider Information | |||||||||
| NPI: | 1134737034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | NADINE | ||||||||
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| Credential: | LCSW, LCSW-PIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1003 MAIN ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815013540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 9709868586 | ||||||||
| Practice Location | |||||||||
| Address1: | 1003 MAIN ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815013540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055042222 | ||||||||
| FaxNumber: | 9709868586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2020 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 5082 | SD | Y | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CSW09928709 | CO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW-PIP6264 | SD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.