Basic Information
| Provider Information | |||||||||
| NPI: | 1174173223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLISLE | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | OKES | ||||||||
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| OtherLastName: | OKES | ||||||||
| OtherFirstName: | BRITTANY | ||||||||
| OtherMiddleName: | RAE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4219 SW JUNEAU ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981361621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062075395 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4219 SW JUNEAU ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981361621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062075395 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2019 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 09926140 | CO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 60986888 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.