Provider Demographics
NPI:1609064534
Name:BRYNJULFSEN, LINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINE
Middle Name:
Last Name:BRYNJULFSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5003
Mailing Address - Street 2:24511 WEST JAYNE AVE.
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-5003
Mailing Address - Country:US
Mailing Address - Phone:559-934-3088
Mailing Address - Fax:
Practice Address - Street 1:24511 WEST JAYNE AVE.
Practice Address - Street 2:COALINGA STATE HOSPITAL
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-5003
Practice Address - Country:US
Practice Address - Phone:559-934-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical