Provider Demographics
NPI:1215233945
Name:BRYAN, JONAH ISAAC (MA)
Entity type:Individual
Prefix:MR
First Name:JONAH
Middle Name:ISAAC
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1282
Mailing Address - Country:US
Mailing Address - Phone:970-290-0336
Mailing Address - Fax:
Practice Address - Street 1:323 W DRAKE RD STE 216
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8120
Practice Address - Country:US
Practice Address - Phone:970-290-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty