Healthcare Provider Details

I. General information

NPI: 1649210998
Provider Name (Legal Business Name): BRIAN EDWIN HOUGH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 SOUTH BLOOMFIELD AVE
NORWALK CA
90650
US

IV. Provider business mailing address

11401 BLOOMFIELD
NORWALK CA
90650
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax: 562-864-4560
Mailing address:
  • Phone: 562-651-5529
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number17012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: