Provider Demographics
NPI:1356864987
Name:BRYAN, LAUREN R (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MARKET STREET SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35808-2670
Mailing Address - Country:US
Mailing Address - Phone:619-354-1227
Mailing Address - Fax:
Practice Address - Street 1:4100 MARKET STREET SW, SUITE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35808-2670
Practice Address - Country:US
Practice Address - Phone:619-354-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA942251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health