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NPI Code Detail

MEDICARE: MR. JEFFREY MICHAEL BRYANT MARRIAGE AND FAMILY

MEDICARE: MR. JEFFREY MICHAEL BRYANT MARRIAGE AND FAMILY
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
1103K00000XBehavior Analyst
2106H00000XMarriage & Family Therapist2023032927MO
3103TR0400XRehabilitation Psychologist
4171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1578870119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY MICHAEL BRYANT MARRIAGE AND FAMILY
Provider Business Mailing Address
First Line : 443 FRANCIS RD
Second Line :
City : BONNE TERRE
State : MO
Zip : 63628-3711
Country : US
Telephone Number : 775-870-6512
Fax Number :
Provider Business Practice Location Address
First Line : 1085 MAPLE ST
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-1955
Country : US
Telephone Number : 573-756-5353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2010
Last Update Date : 06/01/2026

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