Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY60115389 | WA |
N | 103T00000X | Psychologist | PY60115389 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY60115389 | WA |
Y | 103G00000X | Clinical Psychologist | PY.60115389 | WA |
Y | 103TC0700X | Clinical Psychologist | PY.60115389 | WA |
NPI | 1245532753 |
---|---|
Provider Name | Dr. Thomas Kimball Brasted |
First Address | Seattle, WA 98122-2735 |
Second Address | Seattle, WA 98122-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2010 |
Last Update Date | 26/03/2013 |