Provider Demographics
NPI:1366271611
Name:BRYAN, BRENDA MARIE (MS, NCC, LBS, LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MS, NCC, LBS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 STERLING SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4831
Mailing Address - Country:US
Mailing Address - Phone:570-647-6646
Mailing Address - Fax:
Practice Address - Street 1:329 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1505
Practice Address - Country:US
Practice Address - Phone:570-348-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional