Healthcare Provider Details

I. General information

NPI: 1194830554
Provider Name (Legal Business Name): DANIEL M BREWER MA PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32014 LITTLE BOSTON RD NE
KINGSTON WA
98346-9734
US

IV. Provider business mailing address

32014 LITTLE BOSTON RD NE
KINGSTON WA
98346-9734
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-9601
  • Fax: 360-297-9614
Mailing address:
  • Phone: 360-297-9601
  • Fax: 360-297-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH30002492
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: