Active NPI
Peggy Ann Bryan, LCSW
- Clinical Social Worker
- Pierce City, MO
National Provider Identifier
1417109372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 002470
- Practice address
- 104 West Main
Pierce City, MO 65723-2100 - Phone
- (417) 235-6610
- NPI assigned
- Oct 22, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 002470 | MO | Primary |
Addresses
Primary practice location
104 West Main
Pierce City, MO 65723-2100
Mailing address
1874 Lawrence 1095
Miller, MO 65707-7225
Phone (417) 773-1355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002470 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224633600000",
"number": "1417109372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1874 LAWRENCE 1095",
"city": "MILLER",
"state": "MO",
"postal_code": "657077225",
"telephone_number": "417-773-1355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 WEST MAIN",
"city": "PIERCE CITY",
"state": "MO",
"postal_code": "657232100",
"telephone_number": "417-235-6610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYAN",
"first_name": "PEGGY",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-22",
"last_updated": "2008-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "002470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pierce City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.