Individual
BRONSON MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5620 112TH ST E, PUYALLUP, WA 98373-3206
(517) 974-3515
Mailing address
5620 112TH ST E, PUYALLUP, WA 98373-3206
(517) 974-3515
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Enumeration date
02/24/2025
Last updated
02/23/2026
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