Provider Demographics
NPI:1043889314
Name:HARRISON, BRYAN
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 CAMINO DEL RIO N STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1747
Mailing Address - Country:US
Mailing Address - Phone:619-507-9333
Mailing Address - Fax:619-467-4595
Practice Address - Street 1:3570 CAMINO DEL RIO N STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1747
Practice Address - Country:US
Practice Address - Phone:619-507-9333
Practice Address - Fax:619-467-4595
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-07-10
Deactivation Date:2021-11-02
Deactivation Code:
Reactivation Date:2021-11-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator