Provider Demographics
NPI:1467842914
Name:CARTER, BRYANT SR (OWNER)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:
Last Name:CARTER
Suffix:SR
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3863 GENTILLY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-6140
Mailing Address - Country:US
Mailing Address - Phone:504-451-1571
Mailing Address - Fax:504-304-9504
Practice Address - Street 1:3863 GENTILLY BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-6140
Practice Address - Country:US
Practice Address - Phone:504-451-1571
Practice Address - Fax:504-304-9504
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health