Provider Demographics
NPI:1174957559
Name:GREESON, BRYAN DAVID (MA/CAS)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DAVID
Last Name:GREESON
Suffix:
Gender:M
Credentials:MA/CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:1475 EAST LIBERTY STREET
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-0770
Mailing Address - Country:US
Mailing Address - Phone:803-684-9916
Mailing Address - Fax:803-684-1903
Practice Address - Street 1:18 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-0770
Practice Address - Country:US
Practice Address - Phone:803-684-1905
Practice Address - Fax:803-684-1907
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC160769103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC160769OtherBOARD OF ED. EDUCATOR CERTIFICATE