Healthcare Provider Details

I. General information

NPI: 1922626142
Provider Name (Legal Business Name): BRIAN JEFFREY URA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32129 LINDERO CANYON RD STE 209
WESTLAKE VILLAGE CA
91361-5432
US

IV. Provider business mailing address

32129 LINDERO CANYON RD STE 209
WESTLAKE VILLAGE CA
91361-5432
US

V. Phone/Fax

Practice location:
  • Phone: 818-304-8502
  • Fax: 805-557-0015
Mailing address:
  • Phone: 818-304-8502
  • Fax: 805-557-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: