Provider Demographics
NPI:1700336146
Name:ASHBURN, BRIAN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:ASHBURN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 OXBOW AVE E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3851
Mailing Address - Country:US
Mailing Address - Phone:425-395-9605
Mailing Address - Fax:
Practice Address - Street 1:22807 SE 216TH WAY
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8459
Practice Address - Country:US
Practice Address - Phone:425-395-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60899139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist