Provider Demographics
NPI:1033329560
Name:BRYANT, DAVID R (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LCSW
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 2338
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-2338
Mailing Address - Country:US
Mailing Address - Phone:907-424-8000
Mailing Address - Fax:907-424-8116
Practice Address - Street 1:602 CHASE AVENUE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-1092
Practice Address - Country:US
Practice Address - Phone:907-424-8000
Practice Address - Fax:907-424-8116
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical