Individual
MRS. AUDRA JEAN BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS.,LPC., LSW.
Contact information
Practice address
228 E PLAZA ST STE B, PMB#137, EAGLE, ID 83616-5982
(208) 371-5433
Mailing address
228 E PLAZA ST STE B, PMB#137, EAGLE, ID 83616-5982
(208) 371-5433
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-3473
ID
104100000X
Social Worker
LSW-2046
ID
Other
Enumeration date
04/01/2008
Last updated
04/01/2008
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