Provider Demographics
NPI:1871981837
Name:CAUGHELL, MARY C
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:CAUGHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 NW TAYLOR RD.
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:360-373-2536
Mailing Address - Fax:360-373-4934
Practice Address - Street 1:5112 NW TAYLOR RD.
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:360-373-2536
Practice Address - Fax:360-373-4934
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health