Provider Demographics
NPI:1689001604
Name:STUART, BRIAN RUSSELL
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RUSSELL
Last Name:STUART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 MORRISON CT
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4000
Mailing Address - Country:US
Mailing Address - Phone:360-391-4862
Mailing Address - Fax:
Practice Address - Street 1:2325 VINING ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5940
Practice Address - Country:US
Practice Address - Phone:360-930-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA46-1883064OtherEIN