Provider Demographics
NPI:1558489989
Name:BRYANT, AMY L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SEBBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 S HIGLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4704
Mailing Address - Country:US
Mailing Address - Phone:480-240-0386
Mailing Address - Fax:480-240-4151
Practice Address - Street 1:1425 S HIGLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-4704
Practice Address - Country:US
Practice Address - Phone:480-240-0386
Practice Address - Fax:480-240-4151
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW106891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical