Provider Demographics
NPI:1588928816
Name:BRYSON, MICHAEL NATHANIEL (LPCMH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NATHANIEL
Last Name:BRYSON
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 E RADISON RUN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-3837
Mailing Address - Country:US
Mailing Address - Phone:302-223-6723
Mailing Address - Fax:
Practice Address - Street 1:655 S BAY RD STE 5A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4615
Practice Address - Country:US
Practice Address - Phone:302-730-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health