Provider Demographics
NPI:1730687344
Name:BIRCH, MARCUS WILLIAM JOHN
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:WILLIAM JOHN
Last Name:BIRCH
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 1:13204 SE NEWPORT WAY APT E202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2073
Mailing Address - Country:US
Mailing Address - Phone:360-594-8325
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:13204 SE NEWPORT WAY APT E202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-2073
Practice Address - Country:US
Practice Address - Phone:360-594-8325
Practice Address - Fax:206-901-2010
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61099294101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health