Provider Demographics
NPI:1477646230
Name:BRYANT, COLUMBUS B (MSW, PSYD)
Entity type:Individual
Prefix:DR
First Name:COLUMBUS
Middle Name:B
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9339 EAST 21ST STREET NORTH, STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-631-1222
Mailing Address - Fax:316-631-1224
Practice Address - Street 1:9339 EAST 21ST STREET NORTH, STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-631-1222
Practice Address - Fax:316-631-1224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4561Medicare UPIN
KS119809Medicare ID - Type UnspecifiedMEDICARE
KS119809Medicare UPIN