Provider Demographics
NPI:1043790652
Name:BRYANT, KAYLAN (MA)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 W 132ND ST APT 109
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5942
Mailing Address - Country:US
Mailing Address - Phone:323-513-5643
Mailing Address - Fax:
Practice Address - Street 1:4046 W 132ND ST APT 109
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5942
Practice Address - Country:US
Practice Address - Phone:323-513-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist