Healthcare Provider Details

I. General information

NPI: 1205301611
Provider Name (Legal Business Name): BRITNEY BRYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 ALUMNI DRIVE
MEMPHIS TN
38152-0001
US

IV. Provider business mailing address

3675 ALUMNI DRIVE
MEMPHIS TN
38152-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-216-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4302
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: