MEDICARE: ASHLEY RENAE BRYANT M.S., LPC

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	171M00000X	Case Manager/Care Coordinator
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740590264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY RENAE BRYANT M.S., LPC

Provider Business Mailing Address
First Line	:	3801 NW 63RD ST STE 137
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1921
Country	:	US
Telephone Number	:	405-370-4594
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 NW 63RD ST STE 137
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1921
Country	:	US
Telephone Number	:	405-370-4594
Fax Number	:	405-421-9530

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	12/16/2019

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