Provider Demographics
NPI:1750040713
Name:MCEUIN, MARY LOUSIE (SUDPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUSIE
Last Name:MCEUIN
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:STIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA
Mailing Address - Street 1:4841 AUTO CENTER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4388
Mailing Address - Country:US
Mailing Address - Phone:360-373-1529
Mailing Address - Fax:
Practice Address - Street 1:4841 AUTO CENTER WAY STE 101
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4388
Practice Address - Country:US
Practice Address - Phone:360-373-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1990365Medicaid