Basic Information
| Provider Information | |||||||||
| NPI: | 1598435117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRIGGS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | LEVI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 16TH ST STE 316 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850061266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025713163 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2150 FREEMAN RD E | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984243776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539227833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2021 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CG61099654 | WA | N | Behavioral Health & Social Service Providers | Counselor | 175T00000X | CG61099654 | WA | Y |
No ID Information.