=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730682204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE PERHAM COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2018
-----------------------------------------------------
Last Update Date | 03/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5100 S DAWSON ST STE 103
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-973-6152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 S DAWSON ST STE 103
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-973-6152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | BRUCE PERHAM
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 206-973-6152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 60765129
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------