Provider Demographics
NPI:1811416787
Name:BRYANT, BRIA SIMONE (MA, LLC, SCL)
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:SIMONE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA, LLC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ROCHDALE DR S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2275
Mailing Address - Country:US
Mailing Address - Phone:248-832-2228
Mailing Address - Fax:
Practice Address - Street 1:145 ROCHDALE DR S
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2275
Practice Address - Country:US
Practice Address - Phone:248-382-8932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI6451022556101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician