Provider Demographics
NPI:1003373861
Name:CARTER, BRYON SCOTT (AS)
Entity Type:Individual
Prefix:
First Name:BRYON
Middle Name:SCOTT
Last Name:CARTER
Suffix:
Gender:M
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-8082
Mailing Address - Country:US
Mailing Address - Phone:802-279-5176
Mailing Address - Fax:802-595-7581
Practice Address - Street 1:105 HILL ST APT 2
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3940
Practice Address - Country:US
Practice Address - Phone:802-279-5176
Practice Address - Fax:802-595-7581
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty