Healthcare Provider Details

I. General information

NPI: 1417711912
Provider Name (Legal Business Name): BYDAND THERAPY & CONSULTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 15TH ST
CODY WY
82414-3109
US

IV. Provider business mailing address

627 15TH ST
CODY WY
82414-3109
US

V. Phone/Fax

Practice location:
  • Phone: 626-539-3524
  • Fax:
Mailing address:
  • Phone: 626-539-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. COLT GORDON
Title or Position: CEO
Credential: LCSW
Phone: 626-539-3524