Provider Demographics
NPI:1205342383
Name:O'BRYANT, PATRICIA (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:O'BRYANT
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E SLAUGHTER LN APT 3213
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-0074
Mailing Address - Country:US
Mailing Address - Phone:314-494-3955
Mailing Address - Fax:
Practice Address - Street 1:3217 HENNEPIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4695
Practice Address - Country:US
Practice Address - Phone:612-812-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303850101YA0400X
MN01618101YP2500X
MNCC02360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional