Provider Demographics
NPI:1609548296
Name:KENT, BRYAN (LPC-T)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:KENT
Suffix:
Gender:M
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-2230
Mailing Address - Country:US
Mailing Address - Phone:913-963-8636
Mailing Address - Fax:
Practice Address - Street 1:505 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:KS
Practice Address - Zip Code:66075-4095
Practice Address - Country:US
Practice Address - Phone:913-352-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03866-T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty