Healthcare Provider Details

I. General information

NPI: 1730682204
Provider Name (Legal Business Name): BRUCE PERHAM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S DAWSON ST STE 103
SEATTLE WA
98118-2100
US

IV. Provider business mailing address

5100 S DAWSON ST STE 103
SEATTLE WA
98118-2100
US

V. Phone/Fax

Practice location:
  • Phone: 206-973-6152
  • Fax:
Mailing address:
  • Phone: 206-973-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number60765129
License Number StateWA

VIII. Authorized Official

Name: BRUCE PERHAM
Title or Position: THERAPIST
Credential: LICSW
Phone: 206-973-6152