Provider Demographics
NPI:1164562187
Name:EREN, MUAZZEZ O (PHD)
Entity Type:Individual
Prefix:DR
First Name:MUAZZEZ
Middle Name:O
Last Name:EREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0223
Mailing Address - Country:US
Mailing Address - Phone:360-565-0215
Mailing Address - Fax:360-457-8429
Practice Address - Street 1:519 S PEABODY ST STE 6
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6247
Practice Address - Country:US
Practice Address - Phone:360-565-0215
Practice Address - Fax:360-457-8429
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00026296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA591906Medicaid