=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548068471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON HIRDLER BA, SUDPT, R-AAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1126 S GOLD ST
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98531-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-807-4929
-----------------------------------------------------
Fax | 844-612-6673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2394
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-8455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-200-5419
-----------------------------------------------------
Fax | 844-612-6673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | CG70064520
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | CO70054759
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------