Basic Information
| Provider Information | |||||||||
| NPI: | 1770058026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARAH BRYSON COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 S HUNTER ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727303115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797479213 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 SOUTHWINDS RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727308678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792676934 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2018 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | JAMES BRYSON | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 4797479213 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.