Most Relevant Information
Provider Data
| NPI Number: | 1003327610 |
| Provider Name: | MACKENZIE BRYANT GARRISON LBSW |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 36722 |
Most Important Dates
| Enumeration Date: | 10/23/2017 |
| Last Updated: | 10/23/2017 |
Provider Practice Location
1118 F ST # B
LEWISTON
ID
835011930
Practice Location Phone/Fax
| Phone: | 2087994440 |
| Fax: |
Provider Mailing Location
1118 F ST # B
LEWISTON
ID
835011930
Provider Mailing Phone/Fax
| Phone: | 2087994440 |
| Fax: |