Provider Demographics
NPI:1043590839
Name:BRYSON, LAURIE ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:BRYSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 BOLES ROAD
Mailing Address - Street 2:
Mailing Address - City:LABADIE
Mailing Address - State:MO
Mailing Address - Zip Code:63055
Mailing Address - Country:US
Mailing Address - Phone:314-607-6922
Mailing Address - Fax:636-742-2987
Practice Address - Street 1:102 ELM STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090
Practice Address - Country:US
Practice Address - Phone:314-607-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007003657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional