Provider Demographics
NPI:1801093323
Name:BRYSON, CHANTEL (LPCC)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:BRYSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 SUTTER BUTTES DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7134
Mailing Address - Country:US
Mailing Address - Phone:801-824-2365
Mailing Address - Fax:
Practice Address - Street 1:3017 SUTTER BUTTES DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7134
Practice Address - Country:US
Practice Address - Phone:801-824-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6642468-6009101YP2500X
CALPCC14550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional