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General NPI Number Information
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NPI Number | 1063016467
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Entity Type | Individual
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Provider Name | BRYA HANAN MA
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Gender | Female
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 493 E BAYLOR LN
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City | GILBERT
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State | AZ
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Zip | 85296-4152
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Country | US
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Telephone | 310-529-0732
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Fax |
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Provider Business Mailing Address
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Address Line | 493 E BAYLOR LN
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City | GILBERT
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State | AZ
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Zip | 85296-4152
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Country | US
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Telephone | 310-529-0732
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMFT6579T
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2020035071
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMFT119098
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License Number State | CA
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