Provider Demographics
NPI:1942323282
Name:MANION, BRYAN MYLES (MA, LCPC, QMHP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:MYLES
Last Name:MANION
Suffix:
Gender:M
Credentials:MA, LCPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:PO BOX 983
Mailing Address - City:ST JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873
Mailing Address - Country:US
Mailing Address - Phone:214-469-9300
Mailing Address - Fax:217-469-9301
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873
Practice Address - Country:US
Practice Address - Phone:214-469-9300
Practice Address - Fax:217-469-9301
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health