Provider Demographics
NPI:1023869294
Name:BRYANT, BLAKE (LCSW)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 BYERS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-6890
Mailing Address - Country:US
Mailing Address - Phone:214-794-1997
Mailing Address - Fax:
Practice Address - Street 1:1309 BYERS LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6890
Practice Address - Country:US
Practice Address - Phone:214-794-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69071101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor