Individual
CHARLES DOUGLAS BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
373 W HIGHWAY 39 STE 1, BLACKFOOT, ID 83221-5228
(208) 557-9450
(208) 561-7111
Mailing address
444 HOSPITAL WAY STE 422, POCATELLO, ID 83201-2744
(208) 557-9450
(208) 561-7111
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-27872
ID
Other
Enumeration date
04/06/2022
Last updated
04/06/2022
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