Provider Demographics
NPI:1104119015
Name:BRYANT, CARMEN MELANIE (MA, ED D, LMHC)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MELANIE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA, ED D, LMHC
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:MELANIE
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, EDD, LMHC
Mailing Address - Street 1:PO BOX 45549
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98448
Mailing Address - Country:US
Mailing Address - Phone:253-414-4796
Mailing Address - Fax:253-292-2039
Practice Address - Street 1:4301 S PINE ST STE 78
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7252
Practice Address - Country:US
Practice Address - Phone:253-414-4796
Practice Address - Fax:253-292-2039
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60411457101YM0800X
WA60411457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040276Medicaid