Provider Demographics
NPI:1427399773
Name:BEDDOES, BRYAN WILLIAM (LPC, SCHOOL PSYCH)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:WILLIAM
Last Name:BEDDOES
Suffix:
Gender:M
Credentials:LPC, SCHOOL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-3024
Mailing Address - Country:US
Mailing Address - Phone:208-890-3787
Mailing Address - Fax:
Practice Address - Street 1:226 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-3024
Practice Address - Country:US
Practice Address - Phone:208-890-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 5105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health