Provider Demographics
NPI:1912695743
Name:COLEMAN, BRYSON SHELDON
Entity Type:Individual
Prefix:
First Name:BRYSON
Middle Name:SHELDON
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 DON TOMASO DR APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4196
Mailing Address - Country:US
Mailing Address - Phone:213-218-0844
Mailing Address - Fax:
Practice Address - Street 1:1000 S HILL RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4455
Practice Address - Country:US
Practice Address - Phone:818-719-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW108396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health