Provider Demographics
NPI:1891079174
Name:BRYANT, NATHANIEL LEE (MA MFT, LPCI)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:LEE
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MA MFT, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 SW BEEF BEND RD APT 10
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2723
Mailing Address - Country:US
Mailing Address - Phone:503-597-8281
Mailing Address - Fax:
Practice Address - Street 1:7409 SW CAPITOL HWY
Practice Address - Street 2:SUITE 209
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2432
Practice Address - Country:US
Practice Address - Phone:503-597-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist