| Doctor Name: | DR. ANGELIA SHAW BRYANT |
| NPI Number: | 1770868234 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NCC CCMHC CHT LPCC |
| License Number: | 0031 |
| Business Practice Address: | 2976 Highway 910 Suite B Russell Springs, KY - 426428963 |
| Business Phone Number: | 2708664753 |
| Business Fax Number: | |
| Mailing Address: | 2976 Highway 910, RUSSELL SPRINGS |
| State: | KY |
| Postal Code: | 426428963 |
| Phone Number: | 2705661122 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2011 |
| NPI Last Update Date: | 07/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0031 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |