Basic Information
| Provider Information | |||||||||
| NPI: | 1114111895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYGA | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.C.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 W HOSPITALITY LN STE 208 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099635377 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 325 W HOSPITALITY LN STE 208 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099635377 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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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 | 106H00000X | IMF#52228 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 108293 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.