MEDICARE: MR. BRYAN CHAO VUE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14138	MN

General Provider Information

NPI Number	:	1245541630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN CHAO VUE LICSW

Provider Business Mailing Address
First Line	:	2100 WILSON AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4146
Country	:	US
Telephone Number	:	651-771-1301
Fax Number	:	651-771-2542

Provider Business Practice Location Address
First Line	:	2100 WILSON AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4146
Country	:	US
Telephone Number	:	651-771-1301
Fax Number	:	651-771-2542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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