Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | E-0003511 | OH |
NPI | 1033196936 |
---|---|
Provider Name | Dr. Betsy Bryan |
First Address | Warren, OH 44484-2345 |
Second Address | Warren, OH 44484-2345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 08/07/2007 |