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General NPI Number Information
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NPI Number | 1346322237
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Entity Type | Individual
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Provider Name | BRYAN MERSHON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 550 S VERMONT AVE FL 3 COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH
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City | LOS ANGELES
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State | CA
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Zip | 90020-1912
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Country | US
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Telephone | 213-738-6120
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Fax | 213-736-5804
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Provider Business Mailing Address
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Address Line | PO BOX 29
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City | CULVER CITY
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State | CA
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Zip | 90232-0029
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Country | US
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Telephone | 213-738-6120
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Fax | 213-736-5804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 10970
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License Number State | CA
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