Basic Information
| Provider Information | |||||||||
| NPI: | 1053930271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYK | ||||||||
| FirstName: | JOELLE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 CHANTILLY DR NE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303243267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855437 | ||||||||
| FaxNumber: | 4047857874 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 CHANTILLY DR NE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303243267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855437 | ||||||||
| FaxNumber: | 4047857874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY004565 | GA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.