Healthcare Provider Details

I. General information

NPI: 1164918819
Provider Name (Legal Business Name): ALYSSA BRUNTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD STE 420
ENCINO CA
91436-4711
US

IV. Provider business mailing address

15720 VENTURA BLVD STE 420
ENCINO CA
91436-4711
US

V. Phone/Fax

Practice location:
  • Phone: 818-927-0478
  • Fax: 323-927-0408
Mailing address:
  • Phone: 818-927-0478
  • Fax: 323-927-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: