Charles Douglas Bryan

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LMSW-27872 Issued in ID

Practice address

373 W Highway 39 Ste 1
Blackfoot, ID 83221-5228

Phone

(208) 557-9450

Fax

(208) 561-7111

NPI assigned

Apr 6, 2022

Last updated

Apr 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Healing Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pocatello, ID
  • NPI 1568109742
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1689315111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 HOSPITAL WAY STE 422",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012744",
            "telephone_number": "208-557-9450",
            "fax_number": "208-561-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 W HIGHWAY 39 STE 1",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832215228",
            "telephone_number": "208-557-9450",
            "fax_number": "208-561-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "CHARLES",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LMSW-27872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry Lynn Bowman, MS, CCC-SLP
• Bridges of Hope Psychiatry
• Brooke Brown, APRN-CNP
• Lynette Mardel Brown, M.D., PH.D.
• Megan Nicole Broyles, PHARM. D.
• Cody Allen Burgess
• Richard Russell Burt, DDS
• Gary D Call, DO
• Thomas Call, DO
• Camp Hippo Pediatric Therapy LLC

• Clinical Social Worker in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.