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General NPI Number Information
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NPI Number | 1982129508
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Entity Type | Individual
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Provider Name | MR. BRENT CHARLES ULRICI
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Gender | Male
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 08/04/2017
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Provider Practice Location Address
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Address Line | 2986 COLMA ST
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City | PLACERVILLE
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State | CA
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Zip | 95667
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Country | US
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Telephone | 530-748-3706
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Fax | 530-748-3379
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Provider Business Mailing Address
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Address Line | PO BOX 1666 2844 COLOMA ST
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City | PLACERVILL
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State | CA
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Zip | 95667
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Country | US
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Telephone | 530-626-9240
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Fax | 530-626-8992
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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