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NPI Code Detail

MEDICARE: DUSTIN BRYAN

MEDICARE: DUSTIN BRYAN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1070OK

General Provider Information

NPI Number : 1578985107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN BRYAN
Provider Business Mailing Address
First Line : 2727 E. ADMIRAL PL.
Second Line :
City : TULSA
State : OK
Zip : 74110
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7477 E 46TH PL
Second Line :
City : TULSA
State : OK
Zip : 74145-6305
Country : US
Telephone Number : 918-384-0002
Fax Number : 918-384-0004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2014
Last Update Date : 01/12/2026

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Directions to “ DUSTIN BRYAN ” Practice Location

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