Healthcare Provider Details

I. General information

NPI: 1548194210
Provider Name (Legal Business Name): BRYCE LYONS RH0016700126
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

IV. Provider business mailing address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

V. Phone/Fax

Practice location:
  • Phone: 909-884-0840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRH0016700126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: