Healthcare Provider Details

I. General information

NPI: 1417424409
Provider Name (Legal Business Name): RICHMOND BUERTEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2018
Last Update Date: 10/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126-3505
US

IV. Provider business mailing address

5421 57TH STREET CT W APT F3
UNIVERSITY PLACE WA
98467-4326
US

V. Phone/Fax

Practice location:
  • Phone: 206-248-8226
  • Fax:
Mailing address:
  • Phone: 253-353-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: