Healthcare Provider Details

I. General information

NPI: 1740630771
Provider Name (Legal Business Name): CHARLEEN RENEE BRAY AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

IV. Provider business mailing address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-6200
  • Fax: 360-419-3505
Mailing address:
  • Phone: 425-349-6200
  • Fax: 360-419-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: