Healthcare Provider Details

I. General information

NPI: 1902768757
Provider Name (Legal Business Name): BENJAMIN MCCAULEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N 200TH ST STE 213
SHORELINE WA
98133-3213
US

IV. Provider business mailing address

1207 N 200TH ST STE 213
SHORELINE WA
98133-3213
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-9066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.61226426
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: