Provider Demographics
NPI:1215617436
Name:BERNER, KARL FRIEDRICH (SUDPT)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:FRIEDRICH
Last Name:BERNER
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19916 OLD OWEN RD # 510
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9778
Mailing Address - Country:US
Mailing Address - Phone:206-552-0882
Mailing Address - Fax:844-440-2147
Practice Address - Street 1:909 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2031
Practice Address - Country:US
Practice Address - Phone:206-552-0882
Practice Address - Fax:844-440-2147
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61436096101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)