Healthcare Provider Details

I. General information

NPI: 1639674971
Provider Name (Legal Business Name): BRIAN KELLY MCQUADE LICSW/CDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 I ST NE
AUBURN WA
98002-2411
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax: 253-939-6826
Mailing address:
  • Phone: 253-833-7444
  • Fax: 253-661-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60456875
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60727840
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: