Provider Demographics
NPI:1134100027
Name:BRYANT, MARY THOMAS (PHD, LMFT, LMHC, NCC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THOMAS
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD, LMFT, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14499 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 164
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2078
Mailing Address - Country:US
Mailing Address - Phone:813-240-4537
Mailing Address - Fax:813-830-6021
Practice Address - Street 1:14499 N DALE MABRY HWY
Practice Address - Street 2:SUITE 164
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2078
Practice Address - Country:US
Practice Address - Phone:813-240-4537
Practice Address - Fax:813-830-6021
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-5573101Y00000X, 101YM0800X
FLMT-2200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53494OtherNAT'L. BD. CERT. #
FLMH-5573OtherLICENSE NUMBER, LMHC
FLMT-2200OtherLIC. MARRIAGE & FAMILY