Provider Demographics
NPI:1174348874
Name:FURY, NICHOLAS JOSEPH BERGERON
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSEPH BERGERON
Last Name:FURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11017 NE 197TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1757
Mailing Address - Country:US
Mailing Address - Phone:425-214-3368
Mailing Address - Fax:425-214-3368
Practice Address - Street 1:11017 NE 197TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1757
Practice Address - Country:US
Practice Address - Phone:425-214-3368
Practice Address - Fax:425-214-3368
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional