Provider Demographics
NPI:1801959366
Name:BRYANT, GLORIA J (LCSW ACSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 COVERT AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-471-8030
Mailing Address - Fax:812-962-0415
Practice Address - Street 1:4770 COVERT AVE
Practice Address - Street 2:STE 218
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5663
Practice Address - Country:US
Practice Address - Phone:812-471-8030
Practice Address - Fax:812-962-0415
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003424A101YM0800X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34003424AOtherLIC CLINICAL SOC WORKER