Provider Demographics
NPI:1114111895
Name:BRYGA, HEATHER ANNE (MSCC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANNE
Last Name:BRYGA
Suffix:
Gender:F
Credentials:MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W HOSPITALITY LN STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3211
Mailing Address - Country:US
Mailing Address - Phone:909-963-5377
Mailing Address - Fax:
Practice Address - Street 1:325 W HOSPITALITY LN STE 208
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3211
Practice Address - Country:US
Practice Address - Phone:909-963-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF#52228106H00000X
CA108293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist