John Joseph Brucklier, MSW
Individual provider Active NPI Mental Health Counselor · Republic, WA
NPI 1780902122 · NPPES record last updated May 10, 2010
Key facts
- NPI
- 1780902122
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- RC00052748 (WA)
- Practice address
- 42 Klondike
Republic, WA 99166-1266 - Phone
- (509) 775-3341
- Fax
- (509) 775-2937
- NPI assigned
- May 10, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC00052748 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ferry County Counseling Services | Past | Accepting new patients | |
| Ferry County Counseling Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | RC00052748 | WA | Yes |
Addresses
Primary practice location
42 Klondike
Republic, WA 99166-1266
Mailing address
PO Box 1120
Republic, WA 99166-1120
Phone (509) 775-3341
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RC00053748 | Other | WA | DEPARTMENT OF HEALTH |
Other providers in Republic, WA
- Farhad H Alrashedy
- Charlotte Ann Barnett
- Jeannette Arlene Bauer
- Jack Michael Bloom
- Albert David Brauer
- Annette L. Byrd
- Ronald L Casebeer
- Kristi Lee Cassady
- John J Cruz
- Dan Leland Daily
All providers in Republic, WA · Mental Health Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.