Provider Demographics
NPI:1093080632
Name:BRYAN, BILLY JAMES (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:JAMES
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 CYPRESS ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-605-2173
Mailing Address - Fax:318-605-2173
Practice Address - Street 1:1215 CYPRESS ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-605-2173
Practice Address - Fax:318-605-2173
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC 4587101YP2500X
LA4587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional