Provider Demographics
NPI:1275213860
Name:BURCH, BRYTANI (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRYTANI
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRYTANI
Other - Middle Name:MONET
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:10902 KATY FWY APT 408
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4918
Mailing Address - Country:US
Mailing Address - Phone:404-798-6286
Mailing Address - Fax:
Practice Address - Street 1:4651 WOODSTOCK RD # 208-191
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1698
Practice Address - Country:US
Practice Address - Phone:404-798-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional