Individual
BRIAN MATTHEW BOULTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDAT-1
Contact information
Practice address
1270 S ALFRED ST UNIT 351371, LOS ANGELES, CA 90035-8057
(424) 381-1422
Mailing address
1270 S ALFRED ST UNIT 351371, LOS ANGELES, CA 90035-8057
(424) 381-1422
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
CCAP
—
Enumeration date
03/26/2015
Last updated
05/27/2016
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