Healthcare Provider Details

I. General information

NPI: 1457709479
Provider Name (Legal Business Name): BRIAN WRY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILSHIRE BLVD SUITE 1100
LOS ANGELES CA
90048-5501
US

IV. Provider business mailing address

6404 WILSHIRE BLVD SUITE 1100
LOS ANGELES CA
90048-5501
US

V. Phone/Fax

Practice location:
  • Phone: 323-960-5500
  • Fax:
Mailing address:
  • Phone: 323-960-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: