Basic Information
| Provider Information | |||||||||
| NPI: | 1124428511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRABAND | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPCC, LICDC, NCGC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2126 MANSFIELD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436135129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194602389 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2465 COLLINGWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436201153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192418827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2014 | ||||||||
| LastUpdateDate: | 09/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 111050 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | E. 0800410 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.