Provider Demographics
NPI:1780231282
Name:THOMAS, BRYAN K (MS, LPC-US)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MS, LPC-US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28355 E 94TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-5771
Mailing Address - Country:US
Mailing Address - Phone:901-603-6761
Mailing Address - Fax:
Practice Address - Street 1:130 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1443
Practice Address - Country:US
Practice Address - Phone:901-603-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional