Healthcare Provider Details

I. General information

NPI: 1619608445
Provider Name (Legal Business Name): EVELYN G BRYSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 W VINE ST
RADCLIFF KY
40160-1954
US

IV. Provider business mailing address

1929 W VINE ST
RADCLIFF KY
40160-1954
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-1133
  • Fax:
Mailing address:
  • Phone: 844-854-1116
  • Fax: 305-846-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: