Provider Demographics
NPI:1407059249
Name:BRYANT, DANA LYNN (CM-A)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LYNN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CM-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 E 430 RD
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-3674
Mailing Address - Country:US
Mailing Address - Phone:918-679-0237
Mailing Address - Fax:
Practice Address - Street 1:3081 E 430 RD
Practice Address - Street 2:
Practice Address - City:OOLOGAH
Practice Address - State:OK
Practice Address - Zip Code:74053
Practice Address - Country:US
Practice Address - Phone:918-679-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical