Provider Demographics
NPI:1235438318
Name:BRYAN, LISA ANNE (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MARKET ST NE STE 530
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1835
Mailing Address - Country:US
Mailing Address - Phone:503-390-5637
Mailing Address - Fax:503-393-3135
Practice Address - Street 1:3000 MARKET ST NE STE 530
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1835
Practice Address - Country:US
Practice Address - Phone:503-390-5637
Practice Address - Fax:503-393-3135
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health