Provider Demographics
NPI:1598137689
Name:BRYAN, SARAH (LMSW, LCDC, CSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LMSW, LCDC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 US HIGHWAY 68 W
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6910
Mailing Address - Country:US
Mailing Address - Phone:520-977-6232
Mailing Address - Fax:
Practice Address - Street 1:6813 US HIGHWAY 68 W
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-6910
Practice Address - Country:US
Practice Address - Phone:520-977-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11891101YA0400X
TX105188101YA0400X
AZLMSW-130631041C0700X
TX577411041C0700X
KY75331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)