Provider Demographics
NPI:1902331739
Name:USREY, BROOKE A
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:USREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 NW 54TH ST STE 433
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3561
Mailing Address - Country:US
Mailing Address - Phone:206-485-4855
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 54TH ST STE 433
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3561
Practice Address - Country:US
Practice Address - Phone:206-485-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60826793101YM0800X
101YM0800X, 172V00000X
WALH61015613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker