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General NPI Number Information
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NPI Number | 1922680545
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Entity Type | Individual
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Provider Name | BREE ANA BLALOCK SUDP, MHP
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Gender | Female
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1601 E 4TH PLAIN BLVD BLDG 17
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City | VANCOUVER
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State | WA
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Zip | 98661-3717
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Country | US
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Telephone | 360-397-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 6050 41ST AVE SW
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City | SEATTLE
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State | WA
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Zip | 98136-1606
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG61055353
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP60417920
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License Number State | WA
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