Provider Demographics
NPI:1558750968
Name:BRYANT, THOMAS EARL JR (CDP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EARL
Last Name:BRYANT
Suffix:JR
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S. THOR ST.
Mailing Address - Street 2:YFA CONNECTIONS
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-532-2000
Mailing Address - Fax:509-532-2005
Practice Address - Street 1:22 S. THOR ST.
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-532-2000
Practice Address - Fax:509-532-2005
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)