Provider Demographics
NPI:1437645652
Name:BLUEITT, SEAN (QMHS, CDCA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BLUEITT
Suffix:
Gender:M
Credentials:QMHS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1517
Mailing Address - Country:US
Mailing Address - Phone:419-944-8845
Mailing Address - Fax:
Practice Address - Street 1:5550 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1517
Practice Address - Country:US
Practice Address - Phone:419-944-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator