Provider Demographics
NPI:1760217632
Name:BRYANT, ENJALICA JENISE (LPC-A)
Entity type:Individual
Prefix:
First Name:ENJALICA
Middle Name:JENISE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21334 PARK RUN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4810
Mailing Address - Country:US
Mailing Address - Phone:832-367-1611
Mailing Address - Fax:
Practice Address - Street 1:25722 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6705
Practice Address - Country:US
Practice Address - Phone:832-934-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty