Provider Demographics
NPI:1023717303
Name:MARTIN, BRYANA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRYANA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BRYANA
Other - Middle Name:M
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3909 HARVESTMEADE ST APT 1317
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-2813
Mailing Address - Country:US
Mailing Address - Phone:573-366-4791
Mailing Address - Fax:
Practice Address - Street 1:3150 HORTON RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-5905
Practice Address - Country:US
Practice Address - Phone:817-413-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist