Healthcare Provider Details

I. General information

NPI: 1952829160
Provider Name (Legal Business Name): MR. TIMOTHY C BRYSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4283 EL CAJON BLVD STE 100
SAN DIEGO CA
92105-1289
US

IV. Provider business mailing address

4283 EL CAJON BLVD STE 100
SAN DIEGO CA
92105-1289
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-1743
  • Fax:
Mailing address:
  • Phone: 619-521-1743
  • Fax: 619-393-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: