Provider Demographics
NPI:1154767192
Name:ALLRED, BRANDI MICHELLE
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:MICHELLE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:MICHELLE
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12430 83RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4918
Mailing Address - Country:US
Mailing Address - Phone:206-883-8671
Mailing Address - Fax:
Practice Address - Street 1:15803 9TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6244
Practice Address - Country:US
Practice Address - Phone:206-883-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60334296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health