Provider Demographics
NPI:1912314360
Name:BRYAN, CHAD H (LPC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:H
Last Name:BRYAN
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 1:100 NORTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2301
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:586-690-4333
Practice Address - Street 1:5816 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6792
Practice Address - Country:US
Practice Address - Phone:989-244-1888
Practice Address - Fax:989-321-6544
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health