Provider Demographics
NPI:1154826659
Name:OBRYANT, EDNA GERMAINE
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:GERMAINE
Last Name:OBRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19118 FOREST TRACE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5044
Mailing Address - Country:US
Mailing Address - Phone:832-233-7947
Mailing Address - Fax:
Practice Address - Street 1:20550 TOWNSEN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4445
Practice Address - Country:US
Practice Address - Phone:832-233-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13787101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)