Provider Demographics
NPI:1083877443
Name:BRYDON, CATHY (LPC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BRYDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 CENTRAL WAY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5095
Mailing Address - Country:US
Mailing Address - Phone:208-237-1711
Mailing Address - Fax:208-237-5192
Practice Address - Street 1:4460 CENTRAL WAY
Practice Address - Street 2:SUITE #2
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-5095
Practice Address - Country:US
Practice Address - Phone:208-237-1711
Practice Address - Fax:208-237-5192
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health