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Theron Bradley Nystrom
Mental Health Counselor in Vancouver, Washington
NPI 1932689510

Theron Bradley Nystrom is a Mental Health Counselor based in Vancouver, WA and is specialized in Mental Health. Theron Bradley Nystrom practices in Vancouver, WA. The NPI Number for Theron Bradley Nystrom is 1932689510 and holds a License No. CG60883880 (Washington).

The current practice location address for Theron Bradley Nystrom is 1014 Main St, Vancouver, WA and can be reached out via phone at 360-695-1014.

Location: 1014 Main St, Vancouver, WA, 98660-3151
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1932689510
Provider Name
Theron Bradley Nystrom
Credential
Provider Entity Type
Individual
Gender
Male
Address
1014 Main St, Vancouver, WA, 98660-3151
Phone Number
360-695-1014
Fax Number
Provider Enumeration Date
08/14/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1014 Main St
City
Vancouver
State
Washington
Zip
98660-3151
Phone Number
360-695-1014
Fax Number
person
Provider Business Mailing Address Details
Address
1014 Main St
City
Vancouver
State
Washington
Zip
98660-3151
Phone Number
360-695-1014
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
CG60883880 (Washington)
Definition
Definition to come...
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