Healthcare Provider Details

I. General information

NPI: 1780454264
Provider Name (Legal Business Name): AWILDA INES CUEVAS HUGHES LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18435 110TH AVE E
PUYALLUP WA
98374-9017
US

IV. Provider business mailing address

18435 110TH AVE E
PUYALLUP WA
98374-9017
US

V. Phone/Fax

Practice location:
  • Phone: 208-791-0273
  • Fax:
Mailing address:
  • Phone: 208-791-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61367992
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: