Provider Demographics
NPI:1457607442
Name:BRYANT, LISA (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ASHBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1474
Mailing Address - Country:US
Mailing Address - Phone:859-509-8305
Mailing Address - Fax:
Practice Address - Street 1:2800 ASHBROOKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1474
Practice Address - Country:US
Practice Address - Phone:859-509-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional