Provider Demographics
NPI:1366713554
Name:AVIDON, BROOK (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:BROOK
Middle Name:
Last Name:AVIDON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:AVIDON
Other - Last Name:MACKAY-BROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2711 E. MADISON
Mailing Address - Street 2:#210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4749
Mailing Address - Country:US
Mailing Address - Phone:206-632-6399
Mailing Address - Fax:
Practice Address - Street 1:2711 E. MADISON
Practice Address - Street 2:#210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4749
Practice Address - Country:US
Practice Address - Phone:206-632-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH.00005106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health