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General NPI Number Information
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NPI Number | 1568768570
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Entity Type | Individual
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Provider Name | ROSS E BRYAN B.S.B.A., M.A.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 550 WATER ST., STE F2
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City | SANTA CRUZ
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State | CA
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Zip | 95062
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Country | US
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Telephone | 831-688-9288
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1150
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City | APTOS
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State | CA
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Zip | 95001
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Country | US
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Telephone | 831-688-9288
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 53281
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License Number State | CA
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