Provider Demographics
NPI:1164737649
Name:JANICE BRYAN PC
Entity Type:Organization
Organization Name:JANICE BRYAN PC
Other - Org Name:JANICE M BRYAN LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-544-2476
Mailing Address - Street 1:1705 KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2605
Mailing Address - Country:US
Mailing Address - Phone:214-544-2476
Mailing Address - Fax:214-544-2487
Practice Address - Street 1:801 E CAMPBELL RD
Practice Address - Street 2:STE 510
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1890
Practice Address - Country:US
Practice Address - Phone:214-544-2476
Practice Address - Fax:972-744-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty