Healthcare Provider Details

I. General information

NPI: 1174404081
Provider Name (Legal Business Name): BRIAN MCKENZIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 LAKE WASHINGTON BLVD NE STE 201
KIRKLAND WA
98033-7870
US

IV. Provider business mailing address

2507 192ND PL SW
LYNNWOOD WA
98036-4896
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-8918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: