Provider Demographics
NPI:1497114698
Name:MAYNARD, BRYAN (M DIV, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:M DIV, LPC-MHSP
Other - Prefix:MR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M DIV, LPC-MHSP
Mailing Address - Street 1:1909 KINGSLEY CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8547
Mailing Address - Country:US
Mailing Address - Phone:615-516-9985
Mailing Address - Fax:
Practice Address - Street 1:367 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8984
Practice Address - Country:US
Practice Address - Phone:615-516-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health