Provider Demographics
NPI:1356445902
Name:BRYANT, BRENDA KAY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:28 N SAGINAW ST
Mailing Address - Street 2:SUITE 813
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2134
Mailing Address - Country:US
Mailing Address - Phone:248-451-0540
Mailing Address - Fax:248-451-0544
Practice Address - Street 1:28 N SAGINAW ST
Practice Address - Street 2:SUITE 813
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2134
Practice Address - Country:US
Practice Address - Phone:248-451-0540
Practice Address - Fax:248-451-0544
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010589361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8008970060OtherBLUE CROSS BLUE SHIELD
8008970060OtherBLUE CROSS BLUE SHIELD