MEDICARE: BRYCE CONNOR LPC-A

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	101YM0800X	Mental Health Counselor	88454	TX

General Provider Information

NPI Number	:	1871366054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYCE CONNOR LPC-A

Provider Business Mailing Address
First Line	:	2025 MONARCH DR APT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6221
Country	:	US
Telephone Number	:	208-640-1680
Fax Number	:

Provider Business Practice Location Address
First Line	:	7703 N LAMAR BLVD STE 500
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-1055
Country	:	US
Telephone Number	:	208-640-1680
Fax Number	:

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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Directions to “ BRYCE CONNOR LPC-A” Practice Location

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