Provider Demographics
NPI:1285979484
Name:BRYANT, JONI (MA)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ESE LOOP323
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9660
Mailing Address - Country:US
Mailing Address - Phone:903-581-0933
Mailing Address - Fax:903-581-3977
Practice Address - Street 1:1121 ESE LOOP323
Practice Address - Street 2:SUITE 204
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9660
Practice Address - Country:US
Practice Address - Phone:903-581-0933
Practice Address - Fax:903-581-3977
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health