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General NPI Number Information
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NPI Number | 1285878611
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Entity Type | Organization
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Legal Business Name | BRYK COUNSELING LLC
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 1913 ATLANTIC AVE. SUITE 167
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City | WALL
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State | NJ
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Zip | 08736-1029
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Country | US
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Telephone | 732-539-3089
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 ATLANTIC AVE. SUITE 167
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City | WALL
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State | NJ
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Zip | 08736-1029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. LISA J BRYK
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Credential | L.P.C
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Telephone | 732-539-3089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 37PC00366900
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License Number State | NJ
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