Provider Demographics
NPI:1598192254
Name:BRYAN, AYLEEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AYLEEN
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 ARLINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1966
Mailing Address - Country:US
Mailing Address - Phone:951-352-4964
Mailing Address - Fax:951-352-4965
Practice Address - Street 1:10722 ARROW RTE STE 314
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4811
Practice Address - Country:US
Practice Address - Phone:909-484-8888
Practice Address - Fax:909-581-0920
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75510106H00000X
CALMFT105851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty