Individual
CARISSA D BRAVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
70 BOWER DR, MEDFORD, OR 97501-3689
(541) 734-3430
(541) 734-3638
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 734-3430
(541) 734-3638
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
3008
OR
Other
Enumeration date
10/01/2014
Last updated
04/09/2020
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