Provider Demographics
NPI:1114209319
Name:BRYANT, BETHANY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 POST RD E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5364
Mailing Address - Country:US
Mailing Address - Phone:203-221-0627
Mailing Address - Fax:
Practice Address - Street 1:1071 POST RD E
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5364
Practice Address - Country:US
Practice Address - Phone:203-221-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000414106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist