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General NPI Number Information
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NPI Number | 1689823023
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Entity Type | Individual
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Provider Name | HEATHER K BRYAN LPC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 2912 KING ST
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City | JONESBORO
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State | AR
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Zip | 72401-5321
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Country | US
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Telephone | 870-586-6743
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Fax |
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Provider Business Mailing Address
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Address Line | 361 SOUTHWEST DR # 190
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City | JONESBORO
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State | AR
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Zip | 72401-5854
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Country | US
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Telephone | 870-586-6743
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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 | P1409067
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License Number State | AR
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