| Doctor Name: | MR. BRYAN MITCHELL ELLIOTT |
| NPI Number: | 1033126644 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, LMFT |
| License Number: | 14593 |
| Business Practice Address: | 2200 Johnson Ave San Angelo, TX - 769045441 |
| Business Phone Number: | 3259493701 |
| Business Fax Number: | 3259473585 |
| Mailing Address: | 2200 Johnson Ave, SAN ANGELO |
| State: | TX |
| Postal Code: | 769045441 |
| Phone Number: | 3259493701 |
| Fax Number: | 3259473585 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 14593 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |