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Behavioral Health & Social Service Providers Psychologist Addiction (Substance Use Disorder)

Provider NPI: 1366781932

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 425-228-5336  Fax: --

Business Mailing Address:
9609 13TH AVE SW  SEATTLE, WA 98106-2919 US
Tel: (20-6) -354-8494  Fax: --

NPI Information:
NPI: 1366781932
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N103TA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
N103TB0200XBehavioral Health & Social Service Providers
N103TC0700XBehavioral Health & Social Service Providers
N103TC2200XBehavioral Health & Social Service Providers

Other Provider Identifiers:



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