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General NPI Number Information
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NPI Number | 1003849076
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Entity Type | Individual
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Provider Name | JEFFREY SCOTT BRYSON LPC, ALPS, IMFT
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 801 MADISON AVE STE 200 WVDOC PAROLE SERVICES
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City | HUNTINGTON
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State | WV
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Zip | 25704-2561
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Country | US
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Telephone | 304-521-7981
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 716
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-0716
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Country | US
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Telephone | 304-521-7981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1437
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | F113
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License Number State | OH
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