Healthcare Provider Details

I. General information

NPI: 1902570872
Provider Name (Legal Business Name): ALLISON EMILY BARKHURST SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 BETHEL RD SE
PORT ORCHARD WA
98366-2490
US

IV. Provider business mailing address

9238 SE VIEW PARK RD
PORT ORCHARD WA
98367-8669
US

V. Phone/Fax

Practice location:
  • Phone: 360-876-9430
  • Fax:
Mailing address:
  • Phone: 360-850-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60889656
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: