Healthcare Provider Details

I. General information

NPI: 1366286049
Provider Name (Legal Business Name): BRANDY MARIE HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E MAIN ST
VENTURA CA
93001-3310
US

IV. Provider business mailing address

399 DELAWARE DR
VENTURA CA
93001-1218
US

V. Phone/Fax

Practice location:
  • Phone: 916-706-6690
  • Fax:
Mailing address:
  • Phone: 916-706-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1478560822
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: