Provider Demographics
NPI:1740590264
Name:BRYANT, ASHLEY RENAE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENAE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:RENAE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS LPC
Mailing Address - Street 1:3801 NW 63RD ST STE 137
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1921
Mailing Address - Country:US
Mailing Address - Phone:405-370-4594
Mailing Address - Fax:
Practice Address - Street 1:3801 NW 63RD ST STE 137
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1921
Practice Address - Country:US
Practice Address - Phone:405-370-4594
Practice Address - Fax:405-421-9530
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200346790CMedicaid