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NPI Code Detail

MEDICARE: HEATHER K BRYAN LPC

MEDICARE: HEATHER K BRYAN LPC
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
1101YP2500XProfessional CounselorP1409067AR

General Provider Information

NPI Number : 1689823023
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER K BRYAN LPC
Provider Business Mailing Address
First Line : 361 SOUTHWEST DR # 190
Second Line :
City : JONESBORO
State : AR
Zip : 72401-5854
Country : US
Telephone Number : 870-586-6743
Fax Number :
Provider Business Practice Location Address
First Line : 2912 KING ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-5321
Country : US
Telephone Number : 870-586-6743
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2008
Last Update Date : 07/20/2023

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Directions to “ HEATHER K BRYAN LPC” Practice Location

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