Provider Demographics
NPI:1205371473
Name:COLUMBUS B. BRYANT, PSYD, LLC
Entity Type:Organization
Organization Name:COLUMBUS B. BRYANT, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLUMBUS
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:316-631-1222
Mailing Address - Street 1:8100 E 22ND ST N
Mailing Address - Street 2:BUILDING 1400-1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-631-1222
Mailing Address - Fax:316-631-1224
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:BUILDING 1400-1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-631-1222
Practice Address - Fax:316-631-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119809Medicare UPIN