Provider Demographics
NPI:1679819015
Name:BRYANT, LACORI C (MA)
Entity Type:Individual
Prefix:MRS
First Name:LACORI
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1623
Mailing Address - Country:US
Mailing Address - Phone:405-376-3463
Mailing Address - Fax:
Practice Address - Street 1:100 W WILSHIRE BLVD # 220
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9050
Practice Address - Country:US
Practice Address - Phone:405-879-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool