Provider Demographics
NPI:1154695963
Name:RILEY, BRUCE SCOTT (MFT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:SCOTT
Last Name:RILEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 STONEBRYN DR
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1544
Mailing Address - Country:US
Mailing Address - Phone:562-335-6503
Mailing Address - Fax:
Practice Address - Street 1:3516 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4520
Practice Address - Country:US
Practice Address - Phone:562-335-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist