Healthcare Provider Details

I. General information

NPI: 1750291118
Provider Name (Legal Business Name): MR. ERIC BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

44001 GARFIELD RD
CLINTON TWP MI
48038-1100
US

IV. Provider business mailing address

17599 AUGUSTA DR
MACOMB MI
48042-1130
US

V. Phone/Fax

Practice location:
  • Phone: 586-747-0669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: