Provider Demographics
NPI:1689734899
Name:MCCOLLUM, BRYCE ALLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:ALLEN
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-0997
Mailing Address - Country:US
Mailing Address - Phone:509-427-8447
Mailing Address - Fax:509-427-8143
Practice Address - Street 1:350 BULLDOG DR
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648
Practice Address - Country:US
Practice Address - Phone:509-427-8447
Practice Address - Fax:509-427-8143
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA 1685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical