Individual
BRYAN DE VALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 W MAIN ST STE 300, MEDFORD, OR 97501-2728
(541) 821-9559
(541) 702-1236
Mailing address
PO BOX 36, MEDFORD, OR 97501-0003
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
06/10/2021
Last updated
06/10/2021
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