Individual
BRYAN C BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3210 W JEFFERSON BLVD, LOS ANGELES, CA 90018-3230
(626) 533-2647
Mailing address
1501 HUGHES WAY, LONG BEACH, CA 90810-1876
(310) 221-6336
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/31/2013
Last updated
08/24/2015
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