Provider Demographics
NPI:1740530245
Name:BASS-RILEY, BRYAN (LPC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BASS-RILEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1448
Mailing Address - Country:US
Mailing Address - Phone:412-737-4378
Mailing Address - Fax:
Practice Address - Street 1:4415 5TH AVE STE 128
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2654
Practice Address - Country:US
Practice Address - Phone:412-737-4378
Practice Address - Fax:412-844-2060
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional