Healthcare Provider Details

I. General information

NPI: 1871892414
Provider Name (Legal Business Name): MR. BRIAN RAY TUTTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BERNARD ST
BAKERSFIELD CA
93305-3020
US

IV. Provider business mailing address

1575 OLIVE DR
BAKERSFIELD CA
93308-3028
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-1817
  • Fax:
Mailing address:
  • Phone: 661-717-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: