BRYON D JACKSON (NPI# 1124366133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124366133 |
| Entity Type | Individual |
| Full Name | BRYON D JACKSON |
| Credential | CAARR |
| Practice Address |
5930 S Main St #104 Los Angeles CA 90003-1284 |
| Mailing Address |
5930 S. Main Street #104 Los Angeles CA 90003 |
| Practice Telephone | 3233725900 |
| Mailing Telephone | 3233725900 |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2013-01-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306990908 | Bryon Jackson | Internal Medicine | 80 Jesse Hill Jr Dr Se Dept Of, Atlanta, GA 30303-3031 | 2007-01-22 |
| 1407417561 | Bryon Jackson | Behavior Technician | 901 Sneath Ln Ste 105, San Bruno, CA 94066-2415 | 2019-06-27 |
| Street Address |
5930 S MAIN ST #104 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90003-1284 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124391669 | Serge Petrosian | Counselor | 5930 S Main St, Suite 104, Los Angeles, CA 90003-1201 | 2012-02-14 |
| 1114291580 | California Care Corp. | Health Maintenance Organization | 5930 S Main St, Ste.104, Los Angeles, CA 90003-1201 | 2012-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831878 | Didi Hirsch Psychiatric Service | Community/Behavioral Health | 9179 S Main Street, Los Angeles, CA 90003 | 2020-05-04 |
| 1780227207 | Herminia E Galvez | Counselor | 8005 S. Figueroa Street, Business, Los Angeles, CA 90003 | 2019-10-28 |
| 1720567548 | Banty Dental Corporation | Clinic/Center | 5971 S Main Street, Los Angeles, CA 90003 | 2018-08-13 |
| 1932623030 | Mireya Melendez | Case Manager/Care Coordinator | 5849 Crocker Street Unit L, Los Angeles, CA 90003 | 2017-07-31 |
| 1356865810 | Oscar Montes Jr. | Social Worker | 8220 San Pedro St., Los Angeles, CA 90003 | 2017-07-26 |
| 1619407483 | Tonja Benetta Jordan | Registered Nurse | 5850 South Main St, Los Angeles, CA 90003 | 2017-06-14 |
| 1194254581 | Janae Wilson Shepherd | Registered Nurse | 5850 S Main Street, Los Angeles, CA 90003 | 2017-06-08 |
| 1649709049 | Eisha Eishawndra Purvis | Registered Nurse | 5850 S. Main Street, Los Angeles, CA 90003 | 2017-06-08 |
| 1689022477 | Ladan Hariri | Psychiatry & Neurology | 1200 N.state St., Los Angeles, CA 90003 | 2016-06-02 |
| 1811330772 | David Chavez | Dental Assistant | 358 East 76st, Los Angeles, CA 90003 | 2013-04-10 |
| Find all providers in zip 90003 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407457377 | Marian Locke | Counselor | 3901 W Adams Blvd, Los Angeles, CA 90018-1756 | 2020-11-05 |
| 1871193888 | Daniel Luna | Counselor | 811 Beacon Ave, Los Angeles, CA 90017-2113 | 2020-10-28 |
| 1962000240 | Frederick P Delafield Iv | Counselor | 679 1/2 Levering Ave, Los Angeles, CA 90024-2350 | 2020-10-09 |
| 1578179941 | Leo Vasquezawarez | Counselor | 470 E 3rd St # Ab, Los Angeles, CA 90013-1629 | 2020-09-21 |
| 1801401963 | Manuel Gambino | Counselor | 11301 Wilshire Blvd Bldg 337, Los Angeles, CA 90073-1003 | 2020-09-14 |
| 1871107219 | Frances Field | Counselor | 3739 Mentone Ave Apt 7, Los Angeles, CA 90034-6444 | 2020-09-02 |
| 1730707985 | Lucia Miguel | Counselor | 1428 W 59th St, Los Angeles, CA 90047-1209 | 2020-07-13 |
| 1821615220 | Sarah Payne | Counselor | 3217 North Eastern Ave, Los Angeles, CA 90032 | 2020-07-01 |
| 1376168070 | Mercedes Elkoff | Counselor | 1745 Warnall Ave, Los Angeles, CA 90024-5358 | 2020-06-09 |
| 1508481201 | Jeanine Ingram | Counselor | 3815 Lockland Dr, Los Angeles, CA 90008-3533 | 2020-06-09 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90003 |
Please comment or provide details below to improve the information on BRYON D JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.