Provider Demographics
NPI:1689092512
Name:BRICEL, CYRUS P (BA)
Entity Type:Individual
Prefix:MR
First Name:CYRUS
Middle Name:P
Last Name:BRICEL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 TIETON DRIVE, SUITE C
Mailing Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:3801 KERN WAY
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6340
Practice Address - Country:US
Practice Address - Phone:509-574-3267
Practice Address - Fax:509-574-6710
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60438404106E00000X
WABA60829133103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036157Medicaid