Provider Demographics
NPI:1215473202
Name:BROWNING, NICOLE MARIE (MS, LMHC, CDPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:BROWNING
Suffix:
Gender:F
Credentials:MS, LMHC, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-0100
Mailing Address - Country:US
Mailing Address - Phone:503-440-3032
Mailing Address - Fax:
Practice Address - Street 1:811 PACIFIC AVE S STE 7
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3544
Practice Address - Country:US
Practice Address - Phone:503-440-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60595937101Y00000X
OR101YA0400X
WA60880514101YM0800X
WAMC 60566278101YM0800X
WALH60880514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2102553Medicaid
WA2102553Medicaid
WACO 60595937OtherWASHINGTON STATE