MEDICARE: JAMES DARREL BRYARS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	9240-C	AR

General Provider Information

NPI Number	:	1194556753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DARREL BRYARS LCSW

Provider Business Mailing Address
First Line	:	3530 W BELMONT CIR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-6043
Country	:	US
Telephone Number	:	870-654-5790
Fax Number	:	479-397-4793

Provider Business Practice Location Address
First Line	:	308 N 24TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-3295
Country	:	US
Telephone Number	:	870-654-5790
Fax Number	:	479-397-4793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	05/06/2025

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