Healthcare Provider Details

I. General information

NPI: 1073937512
Provider Name (Legal Business Name): NATHAN KUIK MSW, CDP, LSWAIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

IV. Provider business mailing address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

V. Phone/Fax

Practice location:
  • Phone: 206-805-8967
  • Fax:
Mailing address:
  • Phone: 206-805-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number261QR0405X
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: