Provider Demographics
NPI:1124482435
Name:CHRIS BRUBAKER, LLC
Entity type:Organization
Organization Name:CHRIS BRUBAKER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:206-486-4993
Mailing Address - Street 1:2825 EASTLAKE AVE E
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3062
Mailing Address - Country:US
Mailing Address - Phone:206-486-4993
Mailing Address - Fax:206-535-6838
Practice Address - Street 1:2825 EASTLAKE AVE E
Practice Address - Street 2:SUITE 120
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3062
Practice Address - Country:US
Practice Address - Phone:206-486-4993
Practice Address - Fax:206-535-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301735261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)