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NPI Code Detail

MEDICARE: MR. BRYAN MICHAEL PATTERSON

MEDICARE: MR. BRYAN MICHAEL PATTERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1144473562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN MICHAEL PATTERSON
Provider Business Mailing Address
First Line : 12168 MOUNT VERNON AVE APT 7
Second Line :
City : GRAND TERRACE
State : CA
Zip : 92313-5539
Country : US
Telephone Number : 909-370-2384
Fax Number :
Provider Business Practice Location Address
First Line : 572 N ARROWHEAD AVE STE 100
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92401-1217
Country : US
Telephone Number : 909-266-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2008
Last Update Date : 10/29/2008

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Directions to “ MR. BRYAN MICHAEL PATTERSON ” Practice Location

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