Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003448051 |
---|---|
Provider Name | Brandon Zahl |
First Address | Mountlake Ter, WA 98043-4500 |
Second Address | Mountlake Ter, WA 98043-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2020 |
Last Update Date | 24/08/2021 |