Healthcare Provider Details

I. General information

NPI: 1093850984
Provider Name (Legal Business Name): CHAD HUNTER BEAVER M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8309 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

8309 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-3644
  • Fax:
Mailing address:
  • Phone: 253-884-3644
  • Fax:

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: