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1598192734
BRYSON KAY VAUGHAN
POCATELLO, ID
NPI
1598192734
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID LPC-4103)
Enumeration Date
2013-10-02
Last Update Date
2013-10-02
Business Address
-- BRYSON KAY VAUGHAN LPC
110 S. 19TH AVE.
POCATELLO, ID 83201
Phone number: 208-234-4722
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Mailing Address
-- BRYSON KAY VAUGHAN LPC
110 S 19TH AVE
POCATELLO, ID 83201-3312
Phone number: 208-234-4722
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