Healthcare Provider Details

I. General information

NPI: 1104507409
Provider Name (Legal Business Name): BRANDON NICOLE MACIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

401 BROADWAY SUITE 2075
SEATTLE WA
98104
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3000
  • Fax:
Mailing address:
  • Phone: 206-503-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.61467574
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSS.PR.70103114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: