Provider Demographics
NPI:1568144962
Name:BRYANT, JUANDA RUTH (LPC-A)
Entity Type:Individual
Prefix:
First Name:JUANDA
Middle Name:RUTH
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 BELLE CHASE HWY STE 8
Mailing Address - Street 2:P.O. BOX #199
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7138
Mailing Address - Country:US
Mailing Address - Phone:409-241-8810
Mailing Address - Fax:
Practice Address - Street 1:5501 TULLIS DR APT 14-106
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-6453
Practice Address - Country:US
Practice Address - Phone:409-241-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional