Provider Demographics
NPI:1780893669
Name:BRYANT, RUSSELL ALAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ALAN
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:RUSSELL
Other - Middle Name:A
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:1430 EMPIRE CENTRAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4032
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-648-3775
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50263104100000X, 1041C0700X
AK11451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker