Provider Demographics
NPI:1619100831
Name:THE OFFICE OF ADELE M. BRYANT, LLC
Entity Type:Organization
Organization Name:THE OFFICE OF ADELE M. BRYANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-726-2546
Mailing Address - Street 1:410 N REED ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17127 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3405
Practice Address - Country:US
Practice Address - Phone:815-530-4589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000741261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)