Provider Demographics
NPI:1134301237
Name:BRYANT, TERRENCE LYNDELL SR (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:LYNDELL
Last Name:BRYANT
Suffix:SR
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 OAKHAM CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8243
Mailing Address - Country:US
Mailing Address - Phone:407-461-1910
Mailing Address - Fax:407-297-8870
Practice Address - Street 1:4421 OAKHAM CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8243
Practice Address - Country:US
Practice Address - Phone:407-461-1910
Practice Address - Fax:407-297-8870
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health