Provider Demographics
NPI:1780310532
Name:CROW, BRYAN HARDY (MA, LAC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:HARDY
Last Name:CROW
Suffix:
Gender:M
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2522
Mailing Address - Country:US
Mailing Address - Phone:520-403-2751
Mailing Address - Fax:
Practice Address - Street 1:125 E MABEL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6654
Practice Address - Country:US
Practice Address - Phone:520-214-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health