Provider Demographics
NPI:1225638075
Name:GALVAN, BRIANNA MYLISSA
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MYLISSA
Last Name:GALVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12635 GLENSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4728
Mailing Address - Country:US
Mailing Address - Phone:562-777-6205
Mailing Address - Fax:
Practice Address - Street 1:11731 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3675
Practice Address - Country:US
Practice Address - Phone:562-942-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2023-08-24
Deactivation Date:2023-07-05
Deactivation Code:
Reactivation Date:2023-08-16
Provider Licenses
StateLicense IDTaxonomies
CAASW103176101YM0800X, 104100000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner