| Doctor Name: | BRIANN CRUZ MEDINA |
| NPI Number: | 1033558804 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | |
| Business Practice Address: | 100 Kendall Dr Lamar, CO - 81052 |
| Business Phone Number: | 7193367501 |
| Business Fax Number: | 7193367453 |
| Mailing Address: | 711 Barnes Ave, LA JUNTA |
| State: | CO |
| Postal Code: | 81050 |
| Phone Number: | 7193845446 |
| Fax Number: | 7193845672 |
| NPI Enumeration Date: | 06/14/2013 |
| NPI Last Update Date: | 06/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |