Provider Demographics
NPI:1508042821
Name:BRYANT, JULIA D (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:D
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21012 CABIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BORDEN
Mailing Address - State:IN
Mailing Address - Zip Code:47106-7923
Mailing Address - Country:US
Mailing Address - Phone:812-967-7976
Mailing Address - Fax:
Practice Address - Street 1:2843 BROWNSBORO RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1288
Practice Address - Country:US
Practice Address - Phone:502-419-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical