Provider Demographics
NPI:1770662736
Name:NILSEN, BRYAN B (PHD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:B
Last Name:NILSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 WILLAKENZIE RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7090
Mailing Address - Country:US
Mailing Address - Phone:541-344-1810
Mailing Address - Fax:541-984-4039
Practice Address - Street 1:3285 WILLAKENZIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7090
Practice Address - Country:US
Practice Address - Phone:541-344-1810
Practice Address - Fax:541-984-4039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist