Healthcare Provider Details

I. General information

NPI: 1003144312
Provider Name (Legal Business Name): BRENDA CROUTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 PACIFIC AVE
LONG BEACH CA
90806-4312
US

IV. Provider business mailing address

26460 SUMMIT CIR
SANTA CLARITA CA
91350-2991
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-8018
  • Fax:
Mailing address:
  • Phone: 661-254-6630
  • 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: