Provider Demographics
NPI:1063016467
Name:HANAN, BRYA (MA)
Entity type:Individual
Prefix:
First Name:BRYA
Middle Name:
Last Name:HANAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 E BAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4152
Mailing Address - Country:US
Mailing Address - Phone:310-529-0732
Mailing Address - Fax:
Practice Address - Street 1:493 E BAYLOR LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4152
Practice Address - Country:US
Practice Address - Phone:310-529-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT6579T101YM0800X
MO2020035071101YM0800X
CALMFT119098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health