Provider Demographics
NPI:1497325088
Name:BRYANT, KIM BENNALLACK (LMFT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:BENNALLACK
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 E BONNYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4535
Mailing Address - Country:US
Mailing Address - Phone:530-225-0160
Mailing Address - Fax:
Practice Address - Street 1:5885 E BONNYVIEW RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-4535
Practice Address - Country:US
Practice Address - Phone:530-225-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty