Provider Demographics
NPI:1972092450
Name:BRYAN, DAVID J (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BRYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 DOVE BROOK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2702
Mailing Address - Country:US
Mailing Address - Phone:972-885-8987
Mailing Address - Fax:
Practice Address - Street 1:1115 DOVE BROOK DR STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2702
Practice Address - Country:US
Practice Address - Phone:972-885-8987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2024-02-14
Deactivation Date:2024-02-08
Deactivation Code:
Reactivation Date:2024-02-13
Provider Licenses
StateLicense IDTaxonomies
TX73725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional