Healthcare Provider Details

I. General information

NPI: 1003230103
Provider Name (Legal Business Name): BRYANNA OSWALT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 N WICKHAM RD STE 400
MELBOURNE FL
32940-2025
US

IV. Provider business mailing address

6767 N WICKHAM RD STE 400
MELBOURNE FL
32940-2025
US

V. Phone/Fax

Practice location:
  • Phone: 321-631-8569
  • Fax: 321-631-6530
Mailing address:
  • Phone: 321-631-8569
  • Fax: 321-631-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMT3983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: