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General NPI Number Information
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NPI Number | 1861360596
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Entity Type | Individual
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Provider Name | BRANDON WAUTLET
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Gender | Male
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 11080 B AVE
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City | AUBURN
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State | CA
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Zip | 95603-2618
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Country | US
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Telephone | 530-886-3470
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Fax | 530-886-3472
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Provider Business Mailing Address
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Address Line | 5741 ARROWHEAD DR
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City | FORESTHILL
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State | CA
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Zip | 95631-9604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7025621735
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License Number State | CA
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