Healthcare Provider Details

I. General information

NPI: 1871981837
Provider Name (Legal Business Name): MARY C CAUGHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 NW TAYLOR RD.
BREMERTON WA
98312
US

IV. Provider business mailing address

5112 NW TAYLOR RD.
BREMERTON WA
98312
US

V. Phone/Fax

Practice location:
  • Phone: 360-373-2536
  • Fax: 360-373-4934
Mailing address:
  • Phone: 360-373-2536
  • Fax: 360-373-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: