Provider Demographics
NPI:1790906972
Name:STEIN, BRYCE L (CADC)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:L
Last Name:STEIN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642
Mailing Address - Country:US
Mailing Address - Phone:209-223-6412
Mailing Address - Fax:209-223-0920
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642
Practice Address - Country:US
Practice Address - Phone:209-223-6412
Practice Address - Fax:209-223-0920
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3732296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA3732296OtherALCOHOL DRUG COUNSELOR