MEDICARE: IMANI BRYANT LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0024696	CO

General Provider Information

NPI Number	:	1023829397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMANI BRYANT LPCC

Provider Business Mailing Address
First Line	:	3100 ARAPAHOE AVE STE 200
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1050
Country	:	US
Telephone Number	:	720-316-0371
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 ARAPAHOE AVE STE 200
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-1050
Country	:	US
Telephone Number	:	720-316-0371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	06/01/2026

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Directions to “ IMANI BRYANT LPCC” Practice Location

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