Provider Demographics
NPI:1376034199
Name:JONES, BRENNAN CARTER (CDPT)
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:CARTER
Last Name:JONES
Suffix:
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9068
Mailing Address - Country:US
Mailing Address - Phone:360-452-4062
Mailing Address - Fax:
Practice Address - Street 1:3430 E HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9068
Practice Address - Country:US
Practice Address - Phone:360-452-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60817757101YA0400X
WACDPT.CO.60817757101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)