Individual
BRUCE WAYNE AUSTIN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDP
Contact information
Practice address
9930 EVERGREEN WAY STE Z150, EVERETT, WA 98204-3889
(425) 347-5121
(425) 353-6425
Mailing address
9930 EVERGREEN WAY, EVERETT, WA 98204-3883
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60437219
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP60437219
CHEMICAL DEPENDENCY PROFESSIONAL
WA
05
—
CP60437219
—
WA
Enumeration date
12/20/2017
Last updated
12/20/2017
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