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General NPI Number Information
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NPI Number | 1124827654
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Entity Type | Individual
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Provider Name | BARRY KELVIN BRYANT
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Gender | Male
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 333 BRIDGE ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5367
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Country | US
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Telephone | 616-805-3660
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Fax | 616-805-3631
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Provider Business Mailing Address
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Address Line | 1995 SHINING TREE DR NE
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City | BELMONT
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State | MI
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Zip | 49306-8836
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Country | US
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Telephone | 616-690-1768
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Fax | 616-690-1768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451023740
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License Number State | MI
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