Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 240332 | WA |
NPI | 1326361049 |
---|---|
Provider Name | Bryant Cameron Melton |
First Address | Tacoma, WA 98424 |
Second Address | Tacoma, WA 98493-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2010 |
Last Update Date | 09/03/2010 |