Healthcare Provider Details

I. General information

NPI: 1174492425
Provider Name (Legal Business Name): JADYN STEPHANIE DE BRUYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JADE DE BRUYN

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HAMPSHIRE RD
WESTLAKE VILLAGE CA
91361-2510
US

IV. Provider business mailing address

365 E AVENIDA DE LOS ARBOLES # 73
THOUSAND OAKS CA
91360-2975
US

V. Phone/Fax

Practice location:
  • Phone: 818-724-4673
  • Fax:
Mailing address:
  • Phone: 805-443-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number71B66CDF53
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: