MEDICARE: BEVERLY BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	03282	KS
2	103K00000X	Behavior Analyst		TX
3	2355S0801X	Speech-Language Assistant	43105	TX

General Provider Information

NPI Number	:	1134608953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY BRYANT

Provider Business Mailing Address
First Line	:	19401 TOMBALL PKWY APT 213
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3037
Country	:	US
Telephone Number	:	361-728-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	19401 TOMBALL PKWY APT 213
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3037
Country	:	US
Telephone Number	:	361-728-8851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	05/09/2023

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Directions to “ BEVERLY BRYANT ” Practice Location

Language	Start Address	Practice Location

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