Charles Douglas Bryan
Charles Douglas Bryan is a Clinical Social Worker in Blackfoot, Idaho. Licensed in Idaho. Registered with an NPI since 2022.
- Licensed in
- ID
- In the registry since
- 2022
Practice location Address checks out
373 W Highway 39 Ste 1Blackfoot, ID 83221-5228
Phone: (208) 557-9450
Fax: (208) 561-7111
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Clinical Social Worker (primary) | Taxonomy 1041C0700X · Licence LMSW-27872 (ID) |
|---|
Record details
| NPI number | 1689315111 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | April 6, 2022 |
| Last updated in NPPES | April 6, 2022 |
| Certification date | April 6, 2022 |
| Mailing address | 444 Hospital Way Ste 422, Pocatello, ID 83201-2744 |
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