MEDICARE: PRESTON BRYANT

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	RI-B0909150949	CA

General Provider Information

NPI Number	:	1386069276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRESTON BRYANT

Provider Business Mailing Address
First Line	:	640 N SAN JACINTO ST STE A
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-3188
Country	:	US
Telephone Number	:	951-658-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 N SAN JACINTO ST STE A
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-3188
Country	:	US
Telephone Number	:	951-658-2299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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Directions to “ PRESTON BRYANT ” Practice Location

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