Individual
BRANDON AULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1424 TACOMA AVE S, TACOMA, WA 98402-1907
(253) 405-5961
Mailing address
1814 S LAWRENCE ST, TACOMA, WA 98405-2461
(253) 306-2524
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG60617999
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60617999
AGENCY AFFILIATED
WA
Enumeration date
06/28/2016
Last updated
06/28/2016
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