Provider Demographics
NPI:1740040187
Name:LAHTI, BRYAN ROERT (BASC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ROERT
Last Name:LAHTI
Suffix:
Gender:M
Credentials:BASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4348
Mailing Address - Country:US
Mailing Address - Phone:986-895-3881
Mailing Address - Fax:
Practice Address - Street 1:212 16TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4348
Practice Address - Country:US
Practice Address - Phone:986-895-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist