Provider Demographics
NPI:1417109372
Name:BRYAN, PEGGY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
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 1:1874 LAWRENCE 1095
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:MO
Mailing Address - Zip Code:65707-7225
Mailing Address - Country:US
Mailing Address - Phone:417-773-1355
Mailing Address - Fax:
Practice Address - Street 1:104 WEST MAIN
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723-2100
Practice Address - Country:US
Practice Address - Phone:417-235-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0024701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical