Provider Demographics
NPI:1518162502
Name:BRYAN, MARY K (MFT LADC NCAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MFT LADC NCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5750
Mailing Address - Country:US
Mailing Address - Phone:775-882-3945
Mailing Address - Fax:775-882-6126
Practice Address - Street 1:205 S PRATT AVE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4730
Practice Address - Country:US
Practice Address - Phone:775-882-3945
Practice Address - Fax:775-882-6126
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist