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NPI Code Detail

MEDICARE: MR. JONAH ISAAC BRYAN MA

MEDICARE: MR. JONAH ISAAC BRYAN MA
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
1101YM0800XMental Health Counselor0011774CO

General Provider Information

NPI Number : 1215233945
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JONAH ISAAC BRYAN MA
Provider Business Mailing Address
First Line : 2424 COVENTRY CT
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1282
Country : US
Telephone Number : 970-290-0336
Fax Number :
Provider Business Practice Location Address
First Line : 323 W DRAKE RD STE 216
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-8120
Country : US
Telephone Number : 970-290-0336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2011
Last Update Date : 07/21/2022

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