Healthcare Provider Details

I. General information

NPI: 1053814368
Provider Name (Legal Business Name): JAMES BRIAN SLUSHER SR. CDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19201 120TH AVE NE STE 108
BOTHELL WA
98011-9523
US

IV. Provider business mailing address

19201 120TH AVE NE STE 108
BOTHELL WA
98011-9523
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-6541
  • Fax: 425-485-4154
Mailing address:
  • Phone: 425-485-6541
  • Fax: 425-485-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60425031
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCO60425031
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWASHINGTON STATE DEPARTMENT OF HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: