Provider Demographics
NPI:1285948216
Name:BRYANT, VICTORIA (MFT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
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:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-1267
Mailing Address - Country:US
Mailing Address - Phone:562-493-9003
Mailing Address - Fax:
Practice Address - Street 1:109 DOLPHIN AVE APT 3
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5033
Practice Address - Country:US
Practice Address - Phone:562-493-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist