Individual
KEVIN ELIJAH BRYANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1415 MOFFAT CIR, COLORADO SPRINGS, CO 80909-3512
(719) 820-6491
Mailing address
1415 MOFFAT CIR, COLORADO SPRINGS, CO 80909-3512
(719) 820-6491
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
CO
171M00000X
Case Manager/Care Coordinator
—
CO
171W00000X
Contractor
—
CO
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/15/2023
Last updated
05/15/2023
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