Healthcare Provider Details

I. General information

NPI: 1659283190
Provider Name (Legal Business Name): CYNTHIA L BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987 W 111TH ST
CHICAGO IL
60643-4247
US

IV. Provider business mailing address

1987 W 111TH ST
CHICAGO IL
60643-4247
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-1100
  • Fax:
Mailing address:
  • Phone: 773-238-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033411
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: