Provider Demographics
NPI:1376712513
Name:BRANTLEY, KATHERINE ROSE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ROSE
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:PEDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2602 S 38TH ST UNIT 18
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6665
Mailing Address - Country:US
Mailing Address - Phone:253-861-2718
Mailing Address - Fax:253-302-4447
Practice Address - Street 1:7406 27TH ST W STE 30
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4637
Practice Address - Country:US
Practice Address - Phone:253-861-2718
Practice Address - Fax:253-302-4447
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health