| Doctor Name: | MR. BRAD K NYMAN |
| NPI Number: | 1679807499 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISW |
| License Number: | X-06721 |
| Business Practice Address: | 7417 Sunny Vista Rd Joshua Tree, CA - 922523041 |
| Business Phone Number: | 9492948627 |
| Business Fax Number: | |
| Mailing Address: | 1915 Coal Pl Se, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871064026 |
| Phone Number: | 9492948627 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2009 |
| NPI Last Update Date: | 09/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | X-06721 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |