Provider Demographics
NPI:1821672072
Name:BRYANT, MIOSHA ELLENA (LMHC)
Entity Type:Individual
Prefix:
First Name:MIOSHA
Middle Name:ELLENA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GERMONDS VLG APT 4
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1454
Mailing Address - Country:US
Mailing Address - Phone:845-709-7298
Mailing Address - Fax:
Practice Address - Street 1:2 GERMONDS VLG APT 4
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1454
Practice Address - Country:US
Practice Address - Phone:845-709-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011286-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health