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General NPI Number Information
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NPI Number | 1164990016
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Entity Type | Individual
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Provider Name | BRENTON LOVELETTE MSW
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Gender | Male
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 2120 S PLUM ST
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City | SEATTLE
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State | WA
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Zip | 98144-4539
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Country | US
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Telephone | 206-441-3043
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Fax |
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Provider Business Mailing Address
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Address Line | 222 WALL ST STE 100
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City | SEATTLE
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State | WA
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Zip | 98121-1431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CG60146031
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LW61169502
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License Number State | WA
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