Healthcare Provider Details

I. General information

NPI: 1003213091
Provider Name (Legal Business Name): NATASHA BROOKE BRYSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 S VERMONT AVE
LOS ANGELES CA
90007-4203
US

IV. Provider business mailing address

3787 S VERMONT AVE
LOS ANGELES CA
90007-4203
US

V. Phone/Fax

Practice location:
  • Phone: 323-766-2345
  • Fax: 323-766-2369
Mailing address:
  • Phone: 323-766-2345
  • Fax: 323-766-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC3919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: