Healthcare Provider Details

I. General information

NPI: 1366275414
Provider Name (Legal Business Name): CARLOS ENRIQUE YEGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SAND POINT WAY NE # MS -221
SEATTLE WA
98115-7869
US

IV. Provider business mailing address

6901 SAND POINT WAY NE # MS -221
SEATTLE WA
98115-7869
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2164
  • Fax:
Mailing address:
  • Phone:
  • 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: