Provider Demographics
NPI:1952789570
Name:BRYANT, TODD S
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:S
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KAREN AVE STE B203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1271
Mailing Address - Country:US
Mailing Address - Phone:702-893-2002
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:900 KAREN AVE STE B203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1271
Practice Address - Country:US
Practice Address - Phone:702-893-2002
Practice Address - Fax:702-369-3334
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201410642831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV564614980Medicaid