Provider Demographics
NPI:1386418952
Name:BRYANT, MARLA CHRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:CHRISTINE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 RIVERWOOD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8503
Mailing Address - Country:US
Mailing Address - Phone:314-603-0193
Mailing Address - Fax:
Practice Address - Street 1:1032 RIVERWOOD PLACE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8503
Practice Address - Country:US
Practice Address - Phone:314-603-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009030721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional