Provider Demographics
NPI:1629263546
Name:BRYANT-ARCHIBALD, EILEEN (MFT 31292)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BRYANT-ARCHIBALD
Suffix:
Gender:F
Credentials:MFT 31292
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 COEUR D ALENE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4926
Mailing Address - Country:US
Mailing Address - Phone:310-726-7180
Mailing Address - Fax:
Practice Address - Street 1:819 COEUR D ALENE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4926
Practice Address - Country:US
Practice Address - Phone:310-726-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health