Healthcare Provider Details

I. General information

NPI: 1356818678
Provider Name (Legal Business Name): BRITTANY LEA PRINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY LEA WERNER

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 FAWCETT AVE
TACOMA WA
98402-5503
US

IV. Provider business mailing address

5262 OLYMPIC DR NW STE A
GIG HARBOR WA
98335-1795
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5800
  • Fax:
Mailing address:
  • Phone: 253-345-8522
  • Fax: 253-759-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60799087
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60799087
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: