Provider Demographics
NPI:1558029397
Name:MCKINLEY-BRYANT, TALIA NASHIRA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:NASHIRA
Last Name:MCKINLEY-BRYANT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4364
Mailing Address - Country:US
Mailing Address - Phone:321-735-7249
Mailing Address - Fax:321-735-8105
Practice Address - Street 1:4095 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4364
Practice Address - Country:US
Practice Address - Phone:321-307-5102
Practice Address - Fax:321-735-8105
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health