Provider Demographics
NPI:1720696172
Name:SUJU, EVANDER
Entity Type:Individual
Prefix:
First Name:EVANDER
Middle Name:
Last Name:SUJU
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 1:4910 N BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2124
Mailing Address - Country:US
Mailing Address - Phone:206-819-9936
Mailing Address - Fax:
Practice Address - Street 1:4910 N BRISTOL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2124
Practice Address - Country:US
Practice Address - Phone:206-819-9936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor