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NPI Code Detail

MEDICARE: STUART MARTIN BEASLEY CO60961854

MEDICARE: STUART MARTIN BEASLEY CO60961854
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCO60961854WA

General Provider Information

NPI Number : 1821650938
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART MARTIN BEASLEY CO60961854
Provider Business Mailing Address
First Line : 861 MAHOGANY LN NW
Second Line :
City : SILVERDALE
State : WA
Zip : 98383-8905
Country : US
Telephone Number : 360-620-9505
Fax Number :
Provider Business Practice Location Address
First Line : 1415 LUMSDEN RD
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98367-9179
Country : US
Telephone Number : 360-876-9430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2019
Last Update Date : 06/28/2019

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Directions to “ STUART MARTIN BEASLEY CO60961854” Practice Location

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