Healthcare Provider Details

I. General information

NPI: 1295084119
Provider Name (Legal Business Name): BRIAN K STANDSFIELD COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 VAN NUYS BLVD # 125
VAN NUYS CA
91405-4640
US

IV. Provider business mailing address

1011 W ANGELENO AVE # F
BURBANK CA
91506-2238
US

V. Phone/Fax

Practice location:
  • Phone: 818-908-1740
  • Fax: 818-908-3336
Mailing address:
  • Phone: 818-908-1740
  • Fax: 818-908-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: