MEDICARE: MRS. KATHERINE ROSE BRANTLEY MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00004493	WA

General Provider Information

NPI Number	:	1376712513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE ROSE BRANTLEY MS

Provider Business Mailing Address
First Line	:	2602 S 38TH ST UNIT 18
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-7303
Country	:	US
Telephone Number	:	253-861-2718
Fax Number	:	253-212-2852

Provider Business Practice Location Address
First Line	:	7406 27TH ST W STE 30
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4637
Country	:	US
Telephone Number	:	253-861-2718
Fax Number	:	253-212-2852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	07/10/2024

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