Provider Demographics
NPI:1730682204
Name:BRUCE PERHAM COUNSELING
Entity type:Organization
Organization Name:BRUCE PERHAM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-973-6152
Mailing Address - Street 1:5100 S DAWSON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2100
Mailing Address - Country:US
Mailing Address - Phone:206-973-6152
Mailing Address - Fax:
Practice Address - Street 1:5100 S DAWSON ST STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2100
Practice Address - Country:US
Practice Address - Phone:206-973-6152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60765129261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health