Healthcare Provider Details

I. General information

NPI: 1053412999
Provider Name (Legal Business Name): BRIAN LYNN CARLTON ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 179TH ST SE STE. 100
BOTHELL WA
98012-6648
US

IV. Provider business mailing address

3003 179TH ST SE STE. 100
BOTHELL WA
98012-6648
US

V. Phone/Fax

Practice location:
  • Phone: 425-483-3830
  • Fax: 425-949-4042
Mailing address:
  • Phone: 425-483-3830
  • Fax: 425-949-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00001398
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: