Provider Demographics
NPI:1891391181
Name:BRYANT, SAVANNAH MARIE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARIE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 S CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-791-4242
Mailing Address - Fax:
Practice Address - Street 1:71 CONN STREET
Practice Address - Street 2:
Practice Address - City:IVEL
Practice Address - State:KY
Practice Address - Zip Code:41642
Practice Address - Country:US
Practice Address - Phone:606-359-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor