Provider Demographics
NPI:1831383694
Name:KING, BRYAN SCOTT (LPC)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SCOTT
Last Name:KING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N ROSEMONT ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-5213
Mailing Address - Country:US
Mailing Address - Phone:806-674-3017
Mailing Address - Fax:
Practice Address - Street 1:129 N ROSEMONT ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5213
Practice Address - Country:US
Practice Address - Phone:806-674-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional