Provider Demographics
NPI:1699472415
Name:BRYAN, PAUL (MA LPC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24322 PEPPERRELL PLACE ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2661
Mailing Address - Country:US
Mailing Address - Phone:281-347-0560
Mailing Address - Fax:
Practice Address - Street 1:24322 PEPPERRELL PLACE ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2661
Practice Address - Country:US
Practice Address - Phone:713-582-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401001089OtherMICHIGAN