Provider Demographics
NPI:1245591809
Name:BRYAN, FREDERICK C (LPC)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:C
Last Name:BRYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 WINDSOR RD
Mailing Address - Street 2:A232
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2350
Mailing Address - Country:US
Mailing Address - Phone:512-585-1170
Mailing Address - Fax:512-892-8668
Practice Address - Street 1:3112 WINDSOR RD
Practice Address - Street 2:A232
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2350
Practice Address - Country:US
Practice Address - Phone:512-585-1170
Practice Address - Fax:512-892-8668
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional