Healthcare Provider Details

I. General information

NPI: 1508160508
Provider Name (Legal Business Name): BRITTANY PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 150
OXNARD CA
93036
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 150
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8460
  • Fax: 805-981-8461
Mailing address:
  • Phone: 805-981-8460
  • Fax: 805-981-8461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number15-231
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT109074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: