Healthcare Provider Details

I. General information

NPI: 1811611304
Provider Name (Legal Business Name): BRIANNA MARIE BUELL BHS II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18752 BUCKSKIN DR
BLOOMINGTON CA
92316-2758
US

IV. Provider business mailing address

2085 RUSTIN AVE MAIL STOP #1500
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 909-709-1783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: