Provider Demographics
NPI:1659883098
Name:PFLUEGER, PERRY DAVID
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:DAVID
Last Name:PFLUEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W FRANKLIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3518
Mailing Address - Country:US
Mailing Address - Phone:360-462-3016
Mailing Address - Fax:
Practice Address - Street 1:601 W FRANKLIN ST STE A
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3518
Practice Address - Country:US
Practice Address - Phone:360-462-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60776350101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor