Provider Demographics
NPI:1467533018
Name:BRYANT, TAMIKA MIMS
Entity Type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:MIMS
Last Name:BRYANT
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 1:6047 DOCKSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1029
Mailing Address - Country:US
Mailing Address - Phone:619-434-8592
Mailing Address - Fax:
Practice Address - Street 1:8376 HERCULES ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2902
Practice Address - Country:US
Practice Address - Phone:619-667-6891
Practice Address - Fax:619-469-7279
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health