Provider Demographics
NPI:1962875708
Name:LANDWEHR, BRYCE ALAN (LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:ALAN
Last Name:LANDWEHR
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1847
Mailing Address - Country:US
Mailing Address - Phone:205-916-0123
Mailing Address - Fax:205-916-0878
Practice Address - Street 1:701 MONTGOMERY HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1847
Practice Address - Country:US
Practice Address - Phone:205-916-0123
Practice Address - Fax:205-916-0878
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional