| Doctor Name: | DR. NANCY LYNN BRISON-MOLL |
| NPI Number: | 1053410878 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PSY 15243 |
| Business Practice Address: | 965 E Yosemite Ave Ste 18 Manteca, CA - 953365944 |
| Business Phone Number: | 2094834498 |
| Business Fax Number: | 2098240010 |
| Mailing Address: | 965 E Yosemite Ave Ste 18, MANTECA |
| State: | CA |
| Postal Code: | 953365944 |
| Phone Number: | 2094834498 |
| Fax Number: | 2098240010 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 03/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY 15243 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |