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General NPI Number Information
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NPI Number | 1497526586
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Entity Type | Individual
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Provider Name | BRYNN KAYLA SHAVER QMHP-R
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Gender | Female
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 1110 SE ALDER ST STE 301
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City | PORTLAND
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State | OR
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Zip | 97214-2400
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Country | US
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Telephone | 971-221-8664
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 NE COVINGTON LN
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City | BEND
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State | OR
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Zip | 97701-9290
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Country | US
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Telephone | 828-450-3188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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