MEDICARE: BRYANT COMMUNITY OUTREACH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215707849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYANT COMMUNITY OUTREACH LLC

Provider Business Mailing Address
First Line	:	1336 S DECATUR BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8510
Country	:	US
Telephone Number	:	725-312-2110
Fax Number	:	702-974-4213

Provider Business Practice Location Address
First Line	:	1336 S DECATUR BLVD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8510
Country	:	US
Telephone Number	:	725-312-2110
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DESHAWN BRYANT
Credential	:
Telephone Number	:	702-575-0358

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	06/02/2026

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