MEDICARE: ZACHARY BRISSON PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1538878566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY BRISSON PSYD

Provider Business Mailing Address
First Line	:	18420 102ND AVE NE APT 402
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98011-3523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306B LAKE VIEW AVE
Second Line	:
City	:	SNOHOMISH
State	:	WA
Zip	:	98290-1844
Country	:	US
Telephone Number	:	425-330-9557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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