MEDICARE: HALEY BRYANNE STINSON

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

General Provider Information

NPI Number	:	1700441581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY BRYANNE STINSON

Provider Business Mailing Address
First Line	:	2050 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7827
Country	:	US
Telephone Number	:	714-391-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 N TUSTIN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7827
Country	:	US
Telephone Number	:	714-391-3853
Fax Number	:

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

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	06/07/2024

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