Provider Demographics
NPI:1376161919
Name:BRYAN BASS-RILEY LICENSED PROFESSIONAL COUNSELOR, LLC
Entity Type:Organization
Organization Name:BRYAN BASS-RILEY LICENSED PROFESSIONAL COUNSELOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS-RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-737-4378
Mailing Address - Street 1:175 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1448
Mailing Address - Country:US
Mailing Address - Phone:412-737-4378
Mailing Address - Fax:412-844-2060
Practice Address - Street 1:3825 NORTHERN PIKE STE 202
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2161
Practice Address - Country:US
Practice Address - Phone:412-737-4378
Practice Address - Fax:412-844-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)