Provider Demographics
NPI:1184172686
Name:BRYANT, CRYSTAL M (LPC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:OKERGLICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2004 HIGHLAND AVE STE M
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4400
Mailing Address - Country:US
Mailing Address - Phone:715-835-5915
Mailing Address - Fax:715-835-8112
Practice Address - Street 1:2004 HIGHLAND AVE STE M
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4389
Practice Address - Country:US
Practice Address - Phone:715-835-5915
Practice Address - Fax:715-835-8112
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6214-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1184172686Medicaid