Provider Demographics
NPI:1326585324
Name:BRYSON, PHILLIP STANLEY (MSW)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:STANLEY
Last Name:BRYSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3114
Mailing Address - Country:US
Mailing Address - Phone:813-951-7058
Mailing Address - Fax:
Practice Address - Street 1:1169 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3114
Practice Address - Country:US
Practice Address - Phone:813-951-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW099230441041C0700X
FLSW104521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical