Provider Demographics
NPI:1972112415
Name:WARRENSFORD, BRIAN EARL
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EARL
Last Name:WARRENSFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:CEDAR RIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95924-0786
Mailing Address - Country:US
Mailing Address - Phone:530-559-5388
Mailing Address - Fax:
Practice Address - Street 1:170 E MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6542
Practice Address - Country:US
Practice Address - Phone:530-559-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT130106101YM0800X
101YA0400X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program