Healthcare Provider Details

I. General information

NPI: 1427874676
Provider Name (Legal Business Name): LILLIAN BRUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 OAKES AVE
EVERETT WA
98201-4409
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 425-338-7589
  • Fax: 425-771-8400
Mailing address:
  • Phone: 253-833-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61667058
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: