Healthcare Provider Details

I. General information

NPI: 1891079174
Provider Name (Legal Business Name): NATHANIEL LEE BRYANT MA MFT, LPCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 SW CAPITOL HWY SUITE 209
PORTLAND OR
97219-2432
US

IV. Provider business mailing address

11545 SW BEEF BEND RD APT 10
TIGARD OR
97224-2723
US

V. Phone/Fax

Practice location:
  • Phone: 503-597-8281
  • Fax:
Mailing address:
  • Phone: 503-597-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: