Healthcare Provider Details

I. General information

NPI: 1275423865
Provider Name (Legal Business Name): MR. KYE TARIK BRYANT SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CHAPMAN RD STE 201
NEWARK DE
19702-5415
US

IV. Provider business mailing address

256 CHAPMAN RD STE 201
NEWARK DE
19702-5415
US

V. Phone/Fax

Practice location:
  • Phone: 866-230-6434
  • Fax: 866-230-6434
Mailing address:
  • Phone: 302-292-1334
  • Fax: 866-230-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number211845
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: