Provider Demographics
NPI:1053412999
Name:CARLTON, BRIAN LYNN (EDD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LYNN
Last Name:CARLTON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 179TH ST SE
Mailing Address - Street 2:STE. 100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6648
Mailing Address - Country:US
Mailing Address - Phone:425-483-3830
Mailing Address - Fax:425-949-4042
Practice Address - Street 1:3003 179TH ST SE
Practice Address - Street 2:STE. 100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6648
Practice Address - Country:US
Practice Address - Phone:425-483-3830
Practice Address - Fax:425-949-4042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist