Provider Demographics
NPI:1073510582
Name:BRYANT, SUSAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6659
Mailing Address - Country:US
Mailing Address - Phone:501-225-0576
Mailing Address - Fax:501-225-6789
Practice Address - Street 1:1301 WILSON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6659
Practice Address - Country:US
Practice Address - Phone:501-225-0576
Practice Address - Fax:501-225-6789
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR97-10P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U245OtherLOCAL BCBS
AR1932174836OtherCLINIC NPI #
AR5U245OtherLOCAL BCBS