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General NPI Number Information
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NPI Number | 1720222581
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Entity Type | Individual
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Provider Name | ADELE M BRYANT L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 17127 OAK PARK AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-3405
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Country | US
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Telephone | 815-530-4589
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Fax |
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Provider Business Mailing Address
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Address Line | 410 N REED ST
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City | JOLIET
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State | IL
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Zip | 60435-5968
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Country | US
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Telephone | 815-726-2546
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Fax |
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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 | 180000741
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License Number State | IL
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