Provider Demographics
NPI:1295310936
Name:PARADIS, BRYCE ALLYN (MA, LLC)
Entity type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:ALLYN
Last Name:PARADIS
Suffix:
Gender:M
Credentials:MA, LLC
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 5193
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-5193
Mailing Address - Country:US
Mailing Address - Phone:424-234-9591
Mailing Address - Fax:
Practice Address - Street 1:1012 LOMBARD WAY
Practice Address - Street 2:
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646-8564
Practice Address - Country:US
Practice Address - Phone:424-234-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty