Provider Demographics
NPI:1811466733
Name:BURKHOLDER, BRET GERALD (MA, LMHC)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:GERALD
Last Name:BURKHOLDER
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 93RD AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4041
Mailing Address - Country:US
Mailing Address - Phone:253-223-3408
Mailing Address - Fax:
Practice Address - Street 1:3301 BURKE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9054
Practice Address - Country:US
Practice Address - Phone:253-223-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60174417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health