Provider Demographics
NPI:1912608779
Name:BRYSON, TARAICA
Entity Type:Individual
Prefix:
First Name:TARAICA
Middle Name:
Last Name:BRYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CATAWBA WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-8173
Mailing Address - Country:US
Mailing Address - Phone:615-710-8101
Mailing Address - Fax:
Practice Address - Street 1:1202 CATAWBA WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-8173
Practice Address - Country:US
Practice Address - Phone:615-710-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician