Healthcare Provider Details

I. General information

NPI: 1487587515
Provider Name (Legal Business Name): BRYSON LLOYD COLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BUENA VISTA AVE W
SAN FRANCISCO CA
94117-4108
US

IV. Provider business mailing address

3210 62ND AVE
OAKLAND CA
94605-1614
US

V. Phone/Fax

Practice location:
  • Phone: 415-967-7058
  • Fax:
Mailing address:
  • Phone: 415-967-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: