Provider Demographics
NPI:1235550526
Name:BRYAN, RICHARD JAMES (CMHC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:BRYAN
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 N 2620 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1187
Mailing Address - Country:US
Mailing Address - Phone:801-362-1705
Mailing Address - Fax:
Practice Address - Street 1:567 N 2620 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1187
Practice Address - Country:US
Practice Address - Phone:801-362-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6904910-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health