Provider Demographics
NPI:1205100401
Name:BRYANT, ANN BRENE (LBSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:BRENE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:BRENE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11311 GRAND OAK DR APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1259
Mailing Address - Country:US
Mailing Address - Phone:810-282-4150
Mailing Address - Fax:
Practice Address - Street 1:422 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2404
Practice Address - Country:US
Practice Address - Phone:810-496-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085144171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator