Provider Demographics
NPI:1164708269
Name:O'BRYANT, MICHELLE D (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:O'BRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:800 ROCKMEAD DR
Mailing Address - Street 2:132
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2112
Mailing Address - Country:US
Mailing Address - Phone:713-481-2808
Mailing Address - Fax:
Practice Address - Street 1:800 ROCKMEAD DR
Practice Address - Street 2:STE. 132
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2112
Practice Address - Country:US
Practice Address - Phone:713-481-2808
Practice Address - Fax:713-481-2805
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53246104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker