Basic Information
| Provider Information | |||||||||
| NPI: | 1033443346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN SCOY | ||||||||
| FirstName: | BRIANA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 271 N MADISON AVE | ||||||||
| Address2: | APT. 378 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911014468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263959443 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11001 E. VALLEY MALL | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264420710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2009 | ||||||||
| LastUpdateDate: | 09/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | ICAN867 | 01 | CA | LA COUNTY DMH | OTHER |