Provider Demographics
NPI:1194426148
Name:GOBEL, BRYSON
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:
Last Name:GOBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 S COLLEGE AVE APT G
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1647
Mailing Address - Country:US
Mailing Address - Phone:509-386-5225
Mailing Address - Fax:
Practice Address - Street 1:5 W ALDER ST STE 304
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2029
Practice Address - Country:US
Practice Address - Phone:509-240-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health