Lavonne Bryan

Primary specialty

CounselorTaxonomy code 101Y00000X

License

MC602478888 Issued in WA

Practice address

10001 17TH PL S
Lower Level
Seattle, WA 98168-1615

Phone

(206) 766-6976

Fax

(206) 766-6993

NPI assigned

Apr 24, 2012

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

Other names 1

• Lavonne Nicole Baskerville Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1932467321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703",
            "telephone_number": "206-764-3335",
            "fax_number": "206-764-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10001 17TH PL S",
            "address_2": "LOWER LEVEL",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981681615",
            "telephone_number": "206-766-6976",
            "fax_number": "206-766-6993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "LAVONNE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-24",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "MC602478888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAVONNE",
            "last_name": "BASKERVILLE",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Erin Brody Bryan, PH.D.
• Brianna Victoria Bryan, PHARMD
• Courtney E Bryan Jr., LMT
• James Kyle Bryan, MD
• Lais Fabri Bryan
• Mersine Alexis Bryan, MD
• Ruth Bryan, LMFTA
• Shannon L. Bryan, MD
• Tracy C Bryan, PSYD
• Bryant and Junge PS

• Counselor in Seattle, WA
• Providers in Seattle, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.