Provider Demographics
NPI:1003849076
Name:BRYSON, JEFFREY SCOTT (LPC, ALPS, IMFT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:BRYSON
Suffix:
Gender:M
Credentials:LPC, ALPS, IMFT
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 716
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0716
Mailing Address - Country:US
Mailing Address - Phone:304-521-7981
Mailing Address - Fax:
Practice Address - Street 1:801 MADISON AVE STE 200
Practice Address - Street 2:WVDOC PAROLE SERVICES
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2561
Practice Address - Country:US
Practice Address - Phone:304-521-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1437101YP2500X
OHF113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist