Healthcare Provider Details

I. General information

NPI: 1366271611
Provider Name (Legal Business Name): BRENDA MARIE BRYAN MS, NCC, LBS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CHERRY ST
SCRANTON PA
18505-1505
US

IV. Provider business mailing address

181 STERLING SHORE RD
LAKE ARIEL PA
18436-4831
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-6100
  • Fax:
Mailing address:
  • Phone: 570-647-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC017426
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: