Provider Demographics
NPI:1174969091
Name:BRYAN, FERN (LCSW)
Entity type:Individual
Prefix:MS
First Name:FERN
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FERN
Other - Middle Name:M
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4660 BEECHNUT ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1824
Mailing Address - Country:US
Mailing Address - Phone:832-413-1014
Mailing Address - Fax:
Practice Address - Street 1:4660 BEECHNUT ST
Practice Address - Street 2:SUITE 226
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1824
Practice Address - Country:US
Practice Address - Phone:832-413-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-19
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342941041C0700X
IL1490063581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical