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General NPI Number Information
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NPI Number | 1992745483
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Entity Type | Individual
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Provider Name | RENEE COLEMAN BRYER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 409 PLYMOUTH RD. STE. 221
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City | PLYMOUTH
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State | MI
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Zip | 48170
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Country | US
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Telephone | 248-916-7632
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Fax | 734-416-0158
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Provider Business Mailing Address
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Address Line | 409 PLYMOUTH RD. STE. 221
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City | PLYMOUTH
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State | MI
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Zip | 48170
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Country | US
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Telephone | 248-916-7632
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Fax | 734-416-0158
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301011902
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License Number State | MI
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