1538176458 NPI number — MRS. ANN OSULLIVAN BRYNJOLFESSON LMFT

Table of content: MRS. ANN OSULLIVAN BRYNJOLFESSON LMFT (NPI 1538176458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538176458 NPI number — MRS. ANN OSULLIVAN BRYNJOLFESSON LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYNJOLFESSON
Provider First Name:
ANN
Provider Middle Name:
OSULLIVAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSULLIVAN
Provider Other First Name:
ANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538176458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 MAGNOLIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-243-6247
Provider Business Mailing Address Fax Number:
530-243-6247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-243-6247
Provider Business Practice Location Address Fax Number:
530-243-6247
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  25076 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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