Healthcare Provider Details

I. General information

NPI: 1023744034
Provider Name (Legal Business Name): BRYCE C PARMELLY LMFT #164763
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LAS GALLINAS AVE STE 265A
SAN RAFAEL CA
94903-1453
US

IV. Provider business mailing address

PO BOX 141
LAGUNITAS CA
94938-0141
US

V. Phone/Fax

Practice location:
  • Phone: 707-582-5220
  • Fax:
Mailing address:
  • Phone: 707-582-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: