Healthcare Provider Details

I. General information

NPI: 1356929657
Provider Name (Legal Business Name): BRYCIN HANSLITS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRYCIN RILEY

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 NE COURTNEY DR
BEND OR
97701-7636
US

IV. Provider business mailing address

2650 NE COURTNEY DR
BEND OR
97701-7636
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD226172
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: