Provider Demographics
NPI:1760941793
Name:EVANS, BRUCE CHRISTOPHER (MA, CDPT, CMHCA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:CHRISTOPHER
Last Name:EVANS
Suffix:
Gender:M
Credentials:MA, CDPT, CMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17021 114TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5932
Mailing Address - Country:US
Mailing Address - Phone:206-931-0951
Mailing Address - Fax:
Practice Address - Street 1:729 PROSPECT ST STE 200
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5330
Practice Address - Country:US
Practice Address - Phone:360-895-1307
Practice Address - Fax:360-895-4805
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60810714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health