Provider Demographics
NPI:1780021733
Name:BRYAN NIXON COUNSELING, LLC
Entity type:Organization
Organization Name:BRYAN NIXON COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-881-1464
Mailing Address - Street 1:985 PARCHMENT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3659
Mailing Address - Country:US
Mailing Address - Phone:616-425-2412
Mailing Address - Fax:
Practice Address - Street 1:985 PARCHMENT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3659
Practice Address - Country:US
Practice Address - Phone:616-425-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty