Provider Demographics
NPI:1578828547
Name:HALL, BRYAN PATRICK (MS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:PATRICK
Last Name:HALL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 VENTURA BLVD
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2201
Mailing Address - Country:US
Mailing Address - Phone:323-776-9428
Mailing Address - Fax:
Practice Address - Street 1:5946 RADFORD AVE
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1333
Practice Address - Country:US
Practice Address - Phone:323-776-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist