Healthcare Provider Details

I. General information

NPI: 1760500995
Provider Name (Legal Business Name): BRADLEY D WINKEL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040A FITZSIMMONS DRIVE
TACOMA WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4843
  • Fax: 253-968-6887
Mailing address:
  • Phone: 253-968-4843
  • Fax: 253-968-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF00002464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: