Individual
CODY BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1801 SW REDWOOD AVE, BENTONVILLE, AR 72713-7344
(479) 755-9748
Mailing address
4021 W WALNUT ST # 1230, ROGERS, AR 72756-1842
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
A2310005
AR
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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