Provider Demographics
NPI:1710716600
Name:BRYAN, LAUREN TAYLOR (NNC, PRE-LICENSED)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
Last Name:BRYAN
Suffix:
Gender:F
Credentials:NNC, PRE-LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8444
Mailing Address - Country:US
Mailing Address - Phone:802-863-2495
Mailing Address - Fax:
Practice Address - Street 1:125 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8444
Practice Address - Country:US
Practice Address - Phone:802-863-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0132766101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor