Provider Demographics
NPI:1417069162
Name:SHORES, BRYAN ARTHUR SR (MA, CDC-I)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ARTHUR
Last Name:SHORES
Suffix:SR
Gender:M
Credentials:MA, CDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 CORDOVA ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1355
Mailing Address - Country:US
Mailing Address - Phone:907-563-1000
Mailing Address - Fax:
Practice Address - Street 1:733 3RD
Practice Address - Street 2:FERGUSON BUILDING
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:907-442-7749
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional