Provider Demographics
NPI:1134647894
Name:BRYANT, NICOLE (EDD, LCSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 MEMORIAL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5138
Mailing Address - Country:US
Mailing Address - Phone:615-437-7191
Mailing Address - Fax:
Practice Address - Street 1:2650 MEMORIAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5138
Practice Address - Country:US
Practice Address - Phone:615-437-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA995921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7707OtherLCSW
CA99592OtherLCSW