Healthcare Provider Details

I. General information

NPI: 1609068881
Provider Name (Legal Business Name): BRANDON MCKEITH TRIPP MAC, LMHC, SUDP, SAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRANDON TRIPP MAC, LMHC, SUDP, SAP

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 RAINIER AVE S STE C202
SEATTLE WA
98118-2407
US

IV. Provider business mailing address

5600 RAINIER AVE S STE C202
SEATTLE WA
98118-2407
US

V. Phone/Fax

Practice location:
  • Phone: 425-374-1821
  • Fax: 206-327-9508
Mailing address:
  • Phone: 425-374-1821
  • Fax: 206-327-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60038956
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60636433
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: