Healthcare Provider Details

I. General information

NPI: 1720128382
Provider Name (Legal Business Name): BRIAN JAMES DIRRIM M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W AVENUE J SUITE C
LANCASTER CA
93534-3443
US

IV. Provider business mailing address

18437 PRAIRIE ST APT#206
NORTHRIDGE CA
91325-2244
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax:
Mailing address:
  • Phone: 562-479-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: