Healthcare Provider Details

I. General information

NPI: 1821363607
Provider Name (Legal Business Name): BRANDI N HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E PIONEER
PUYALLUP WA
98372-3265
US

IV. Provider business mailing address

325 E PIONEER
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-8120
  • Fax: 253-697-3730
Mailing address:
  • Phone: 253-445-8120
  • Fax: 253-697-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60639263
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60389566
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: