=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992883490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG J BRYAN PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3650 OLENTANGY RIVER RD FL 3
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-293-9600
-----------------------------------------------------
Fax | 614-293-1456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 ACKERMAN RD STE 2120
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43202-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-293-9600
-----------------------------------------------------
Fax | 614-293-1456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 8212872-2501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 048.0135267
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | P.08179
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------