Individual
BRYAN LEE HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
1201 NE 7TH ST STE C, GRANTS PASS, OR 97526
(541) 890-1965
Mailing address
1201 NE 7TH ST STE C, GRANTS PASS, OR 97526-1451
(541) 890-1965
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3564
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679509
—
OR
Enumeration date
02/28/2011
Last updated
08/08/2018
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