Provider Demographics
NPI:1003317181
Name:BRYANT, MONALISA G (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MONALISA
Middle Name:G
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53732
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77052-3732
Mailing Address - Country:US
Mailing Address - Phone:346-444-9038
Mailing Address - Fax:
Practice Address - Street 1:3000 WESLAYAN ST STE 274
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5740
Practice Address - Country:US
Practice Address - Phone:346-444-9038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional