Healthcare Provider Details

I. General information

NPI: 1386378867
Provider Name (Legal Business Name): BRANGWYN URSULA FOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 BEACH COURT
LOTUS CA
95651
US

IV. Provider business mailing address

3101 GARDEN CIR APT 20
CAMERON PARK CA
95682-8525
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-7252
  • Fax:
Mailing address:
  • Phone: 530-727-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1445230921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: