Provider Demographics
NPI:1720347958
Name:MARY T. BRYANT, PA
Entity type:Organization
Organization Name:MARY T. BRYANT, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-240-4537
Mailing Address - Street 1:5121 EHRLICH RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2049
Mailing Address - Country:US
Mailing Address - Phone:813-240-4537
Mailing Address - Fax:813-830-6021
Practice Address - Street 1:5121 EHRLICH RD
Practice Address - Street 2:SUITE 104B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2049
Practice Address - Country:US
Practice Address - Phone:813-240-4537
Practice Address - Fax:813-830-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-5573101YM0800X
FLMT-2200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty