Individual
BLAKE BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1304 CHERRY ST, VAN BUREN, AR 72956-4543
(479) 310-9096
Mailing address
1304 CHERRY ST, VAN BUREN, AR 72956-4543
(479) 310-9096
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A2102206
AR
Other
Enumeration date
03/09/2021
Last updated
03/09/2021
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