Basic Information
| Provider Information | |||||||||
| NPI: | 1386378867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOLEY | ||||||||
| FirstName: | BRANGWYN | ||||||||
| MiddleName: | URSULA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 GARDEN CIR APT 20 | ||||||||
| Address2: | |||||||||
| City: | CAMERON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956828525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307274002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 838 BEACH COURT | ||||||||
| Address2: | |||||||||
| City: | LOTUS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306267252 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2022 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1445230921 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.