Active NPI
Brenna McDaniel
- Addiction (Substance Use Disorder) Counselor
- Graham, WA
National Provider Identifier
1205592961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CO61218359
- Practice address
- 21120 Meridian E
Graham, WA 98338-8254 - Phone
- (253) 285-4750
- Fax
- (253) 375-6203
- NPI assigned
- Nov 16, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CO61218359 | WA | Primary |
Addresses
Primary practice location
21120 Meridian E
Graham, WA 98338-8254
Mailing address
2403 12TH Street PL SW
Puyallup, WA 98373-3729
Phone (253) 569-8324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO61218359 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637020800000",
"number": "1205592961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2403 12TH STREET PL SW",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983733729",
"telephone_number": "253-569-8324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21120 MERIDIAN E",
"city": "GRAHAM",
"state": "WA",
"postal_code": "983388254",
"telephone_number": "253-285-4750",
"fax_number": "253-375-6203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDANIEL",
"first_name": "BRENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-16",
"last_updated": "2021-11-16",
"certification_date": "2021-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CO61218359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Graham, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.