Provider Demographics
NPI:1407366677
Name:PERHAM, BRUCE WILLIAM (LICSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:PERHAM
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 S DAWSON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2100
Mailing Address - Country:US
Mailing Address - Phone:206-973-6152
Mailing Address - Fax:
Practice Address - Street 1:5100 S DAWSON ST STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2100
Practice Address - Country:US
Practice Address - Phone:206-973-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWI.LW.60765129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASWI.LW.60765129OtherSTATE OF WASHINGTON