Basic Information
| Provider Information | |||||||||
| NPI: | 1518162502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRYAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MFT LADC NCAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2621 MEADOWBROOK LN | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897015750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758823945 | ||||||||
| FaxNumber: | 7758826126 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 S PRATT AVE | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897014730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758823945 | ||||||||
| FaxNumber: | 7758826126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 510 | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.