Provider Demographics
NPI:1174679294
Name:BRYAN, TRISHA CHRISTINE (LMSW, CAC-1)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:CHRISTINE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LMSW, CAC-1
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:PRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-0210
Mailing Address - Country:US
Mailing Address - Phone:989-999-8463
Mailing Address - Fax:
Practice Address - Street 1:8702 WANDERING WAY
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9557
Practice Address - Country:US
Practice Address - Phone:989-999-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801085500OtherLMSW
1174679294OtherNPI