Healthcare Provider Details

I. General information

NPI: 1396919692
Provider Name (Legal Business Name): CHANDREA PUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 W MCGRAW ST STE 212
SEATTLE WA
98199-3239
US

IV. Provider business mailing address

4062 ALABASTER ST SE
LACEY WA
98503-2184
US

V. Phone/Fax

Practice location:
  • Phone: 206-453-4882
  • Fax:
Mailing address:
  • Phone: 706-358-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: