Individual
TRACEY RENEE BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
931 E MAIN STREET, CECILIA, KY 42724-9624
(444) 350-9005
(270) 858-4029
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4607
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
164670
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12164366
CAQH
—
05
—
7100394470
—
KY
Enumeration date
09/21/2010
Last updated
07/18/2023
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