| Doctor Name: | BRYAN THORSON |
| NPI Number: | 1154754463 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW |
| License Number: | 149.015165 |
| Business Practice Address: | 9666 Olive Blvd Suite 690 Olivette, MO - 631323013 |
| Business Phone Number: | 3149522426 |
| Business Fax Number: | |
| Mailing Address: | 9666 Olive Blvd, Suite 690 OLIVETTE |
| State: | MO |
| Postal Code: | 631323013 |
| Phone Number: | 3149522426 |
| Fax Number: | |
| NPI Enumeration Date: | 08/11/2013 |
| NPI Last Update Date: | 04/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149.015165 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |