Individual
DR. GLENN TAYLOR BRASINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
429 N WATER ST, SILVERTON, OR 97381-1645
(503) 310-9157
(503) 873-6340
Mailing address
PO BOX 962, SILVERTON, OR 97381-0962
(503) 310-9157
(503) 873-6340
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
211
HI
103TC1900X
Counseling Psychologist
Primary
856
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R000TCHMF
MEDICARE-TYPE UNSPECIFIED
OR
Enumeration date
08/15/2006
Last updated
07/14/2009
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