Healthcare Provider Details

I. General information

NPI: 1023829397
Provider Name (Legal Business Name): IMANI BRYANT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 ARAPAHOE AVE STE 200
BOULDER CO
80303-1050
US

IV. Provider business mailing address

3100 ARAPAHOE AVE STE 200
BOULDER CO
80303-1050
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-0371
  • Fax:
Mailing address:
  • Phone: 720-316-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024696
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: