Provider Demographics
NPI:1427661578
Name:COULSON, PHILLIP RYAN
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:RYAN
Last Name:COULSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 E SPRING ST APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4621
Mailing Address - Country:US
Mailing Address - Phone:206-290-3229
Mailing Address - Fax:
Practice Address - Street 1:2033 6TH AVE FL 4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2573
Practice Address - Country:US
Practice Address - Phone:206-323-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor