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NPI Code Detail

MEDICARE: BRYAN COUNSELING INC.

MEDICARE: BRYAN COUNSELING INC.
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 : 1376064923
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRYAN COUNSELING INC.
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 : PRESIDENT
Name : JONAH ISAAC BRYAN
Credential : MA
Telephone Number : 970-290-0336
Provider Enumeration Date : 07/05/2017
Last Update Date : 07/05/2017

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