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NPI Code Detail

MEDICARE: BRYAN PEPPARD MA

MEDICARE: BRYAN PEPPARD MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1790015295
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN PEPPARD MA
Provider Business Mailing Address
First Line : 10714 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4046
Country : US
Telephone Number : 503-253-2453
Fax Number : 503-254-4271
Provider Business Practice Location Address
First Line : 10714 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4046
Country : US
Telephone Number : 503-253-2453
Fax Number : 503-254-4271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2010
Last Update Date : 01/05/2010

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Directions to “ BRYAN PEPPARD MA” Practice Location

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