Provider Demographics
NPI:1427404987
Name:BRYANT, ARTHUR THOMAS JR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:THOMAS
Last Name:BRYANT
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11594 COLORADO AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2953
Mailing Address - Country:US
Mailing Address - Phone:612-201-3296
Mailing Address - Fax:
Practice Address - Street 1:11594 COLORADO AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2953
Practice Address - Country:US
Practice Address - Phone:612-201-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health