Healthcare Provider Details

I. General information

NPI: 1447309331
Provider Name (Legal Business Name): BRYAN ALAN FRY MA, RC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14216 NE 21ST ST
BELLEVUE WA
98007-3720
US

IV. Provider business mailing address

1600 E OLIVE ST SEATTLE MENTAL HEALTH
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 425-653-4966
  • Fax: 425-653-4910
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00051160
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: