Provider Demographics
NPI:1558977108
Name:CHRISTIANSON, BRYCE MATTHEW
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:MATTHEW
Last Name:CHRISTIANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MULCHATNA DR APT 2
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-3867
Mailing Address - Country:US
Mailing Address - Phone:907-232-5795
Mailing Address - Fax:
Practice Address - Street 1:300 W SWANSON AVE # 512
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6844
Practice Address - Country:US
Practice Address - Phone:907-521-0890
Practice Address - Fax:907-357-0891
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician