Provider Demographics
NPI:1215799010
Name:BRYANT, JERI (PLPC)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1889
Mailing Address - Country:US
Mailing Address - Phone:314-368-2409
Mailing Address - Fax:314-442-4139
Practice Address - Street 1:12 FEE FEE RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2729
Practice Address - Country:US
Practice Address - Phone:314-368-2409
Practice Address - Fax:314-442-4139
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health