Individual
MR. BRENT WILLIAM MICHAUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1616 S. GOLD ST. #4, CENTRALIA, WA 98531-0001
(360) 807-4929
(360) 807-4160
Mailing address
PO BOX 2394, LONGVIEW, WA 98632
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60944835
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2130057
—
WA
Enumeration date
06/28/2017
Last updated
10/30/2020
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