Provider Demographics
NPI:1699496182
Name:BRYANT, VERNON L SR (CPRS)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:L
Last Name:BRYANT
Suffix:SR
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HUDSON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3132
Mailing Address - Country:US
Mailing Address - Phone:234-201-3914
Mailing Address - Fax:
Practice Address - Street 1:3110 HUDSON AVE APT 1
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3132
Practice Address - Country:US
Practice Address - Phone:234-201-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
OHAPS.003237175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)