Organization
GREATER LAKES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN L NICHOLSON BSN (RN)
(253) 620-5015
Entity
Organization
Contact information
Practice address
9330 59TH AVE SW, LAKEWOOD, WA 98499-2858
(253) 620-5015
Mailing address
9330 59TH AVE SW, TACOMA, WA 98499-2858
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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