Individual
BRADLEY BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 W 4TH AVE, ELLENSBURG, WA 98926-3060
(509) 575-4084
Mailing address
PO BOX 959, YAKIMA, WA 98907-0959
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CG60507900
WA
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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