Individual
BRYSON KAY VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
110 S. 19TH AVE., POCATELLO, ID 83201
(208) 234-4722
Mailing address
110 S 19TH AVE, POCATELLO, ID 83201-3312
(208) 234-4722
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LPC-4103
ID
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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