Individual
SAMUEL PAUL BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1024 W FREMONT AVE, MESA, AZ 85210-9316
(480) 213-8452
Mailing address
1024 W FREMONT AVE, MESA, AZ 85210-9316
(480) 213-8452
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-17894
AZ
101YM0800X
Mental Health Counselor
LPC-17894
AZ
101YP2500X
Professional Counselor
Primary
LPC-17894
AZ
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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