Healthcare Provider Details

I. General information

NPI: 1659826709
Provider Name (Legal Business Name): TROY BJERKNESS CRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W VALERIO ST
SANTA BARBARA CA
93101-2930
US

IV. Provider business mailing address

PO BOX 551
SANTA BARBARA CA
93102-0551
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-2785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: