Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003385915 |
---|---|
Provider Name | Brian Hannah |
First Address | Seattle, WA 98144-4644 |
Second Address | Seattle, WA 98144-4644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 20/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1026117 | (05) | WA |