Provider Demographics
NPI:1992745483
Name:BRYER, RENEE COLEMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:COLEMAN
Last Name:BRYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 PLYMOUTH RD.
Mailing Address - Street 2:STE. 221
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:248-916-7632
Mailing Address - Fax:734-416-0158
Practice Address - Street 1:409 PLYMOUTH RD.
Practice Address - Street 2:STE. 221
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:248-916-7632
Practice Address - Fax:734-416-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
MI6301011902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist