Provider Demographics
NPI:1164031480
Name:AMELL, JOHN BRADLEY (PEER COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRADLEY
Last Name:AMELL
Suffix:
Gender:M
Credentials:PEER COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2304
Mailing Address - Country:US
Mailing Address - Phone:206-464-1570
Mailing Address - Fax:206-624-4196
Practice Address - Street 1:222 WALL ST # 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1431
Practice Address - Country:US
Practice Address - Phone:206-441-3043
Practice Address - Fax:206-441-4155
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60920290175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist