MEDICARE: KATHRYN BRYAN

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	106H00000X	Marriage & Family Therapist	43235	CA

General Provider Information

NPI Number	:	1689841629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN BRYAN

Provider Business Mailing Address
First Line	:	22978 EL TORO RD
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4961
Country	:	US
Telephone Number	:	510-317-1444
Fax Number	:

Provider Business Practice Location Address
First Line	:	22978 EL TORO RD
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4961
Country	:	US
Telephone Number	:	510-317-1444
Fax Number	:

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

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	12/08/2021

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Directions to “ KATHRYN BRYAN ” Practice Location

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