Healthcare Provider Details

I. General information

NPI: 1366259335
Provider Name (Legal Business Name): BRYSE L HOLYOAK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 2ND AVE N STE 201
TWIN FALLS ID
83301-6163
US

IV. Provider business mailing address

155 2ND AVE N STE 201
TWIN FALLS ID
83301-6163
US

V. Phone/Fax

Practice location:
  • Phone: 208-751-0478
  • Fax:
Mailing address:
  • Phone: 208-751-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6961475
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6961475
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: