Provider Demographics
NPI:1477821171
Name:BURWELL, BRIAN GRAHAM (CDPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GRAHAM
Last Name:BURWELL
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:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-1228
Mailing Address - Country:US
Mailing Address - Phone:360-394-8558
Mailing Address - Fax:360-598-1724
Practice Address - Street 1:18490 SUQUAMISH WAY NE UNIT 107
Practice Address - Street 2:
Practice Address - City:SUQUAMISH
Practice Address - State:WA
Practice Address - Zip Code:98392-9533
Practice Address - Country:US
Practice Address - Phone:360-394-8558
Practice Address - Fax:360-598-1724
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60163916101YA0400X
WASC606566541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical