Provider Demographics
NPI:1073092912
Name:BRYCE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BRYCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 S 1100 E APT 9
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2427
Mailing Address - Country:US
Mailing Address - Phone:801-673-1320
Mailing Address - Fax:
Practice Address - Street 1:724 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1830
Practice Address - Country:US
Practice Address - Phone:801-487-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor