1760941793 NPI number — BRUCE CHRISTOPHER EVANS MA, CDPT, CMHCA

Table of content: BRUCE CHRISTOPHER EVANS MA, CDPT, CMHCA (NPI 1760941793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760941793 NPI number — BRUCE CHRISTOPHER EVANS MA, CDPT, CMHCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
BRUCE
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CDPT, CMHCA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760941793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17021 114TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98055-5932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-931-0951
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 PROSPECT ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-895-1307
Provider Business Practice Location Address Fax Number:
360-895-4805
Provider Enumeration Date:
03/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MC60810714 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com