Provider Demographics
NPI:1336570662
Name:MC NATT, EUGENE ROBERT (MC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:ROBERT
Last Name:MC NATT
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 3RD AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3300
Mailing Address - Country:US
Mailing Address - Phone:206-765-0988
Mailing Address - Fax:
Practice Address - Street 1:310 3RD AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3300
Practice Address - Country:US
Practice Address - Phone:206-765-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00005794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH 00005794OtherWASHINGTON STATE DEPARTMENT OF HEALTH