Provider Demographics
NPI:1306084199
Name:OLDHAM, BRYN (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:BRYN
Middle Name:
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6306
Mailing Address - Country:US
Mailing Address - Phone:330-274-6238
Mailing Address - Fax:
Practice Address - Street 1:1268 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6306
Practice Address - Country:US
Practice Address - Phone:330-274-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHC0700272101YP2500X
OH0700272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)