Provider Demographics
NPI:1073806576
Name:BRIAN DESROCHES, INC.
Entity Type:Organization
Organization Name:BRIAN DESROCHES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESROCHES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:206-323-6114
Mailing Address - Street 1:2719 E MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4752
Mailing Address - Country:US
Mailing Address - Phone:206-323-6114
Mailing Address - Fax:
Practice Address - Street 1:2719 E MADISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4752
Practice Address - Country:US
Practice Address - Phone:206-323-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1459261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health