Provider Demographics
NPI:1508519315
Name:BRYAN, MICHAEL TYLER (LPC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TYLER
Last Name:BRYAN
Suffix:
Gender:M
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7698 W INNUTIAN CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1063
Mailing Address - Country:US
Mailing Address - Phone:928-691-0069
Mailing Address - Fax:928-691-0069
Practice Address - Street 1:7698 W INNUTIAN CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-1063
Practice Address - Country:US
Practice Address - Phone:928-691-0069
Practice Address - Fax:928-691-0069
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10667101YP2500X
AZ3316887101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional