Provider Demographics
NPI:1689823023
Name:BRYAN, HEATHER K (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 SOUTHWEST DR # 190
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5854
Mailing Address - Country:US
Mailing Address - Phone:870-586-6743
Mailing Address - Fax:
Practice Address - Street 1:2912 KING ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5321
Practice Address - Country:US
Practice Address - Phone:870-586-6743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1409067101YP2500X
AR101YM0800X
ARP14409067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5EE62OtherBCBS
AR1194459917OtherMIND ALIGN COUNSELING GROUP NPI