Provider Demographics
NPI:1881054799
Name:DAWSON, BRUNETTE (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:BRUNETTE
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:DR
Other - First Name:BRUNETTE
Other - Middle Name:
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:12224 NE BEL RED RD # 712
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2451
Mailing Address - Country:US
Mailing Address - Phone:206-880-1571
Mailing Address - Fax:
Practice Address - Street 1:1740 NW MAPLE ST STE 210
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8127
Practice Address - Country:US
Practice Address - Phone:206-880-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61062059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health