Provider Demographics
NPI:1871827386
Name:MCALLISTER, BRADY JAMES
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:JAMES
Last Name:MCALLISTER
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 1:3990 SW 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2546
Mailing Address - Country:US
Mailing Address - Phone:541-852-8528
Mailing Address - Fax:
Practice Address - Street 1:3990 SW 91ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2546
Practice Address - Country:US
Practice Address - Phone:541-852-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health