Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MC60252055 | WA |
NPI | 1003193749 |
---|---|
Provider Name | Matthew D Eisenhower |
First Address | Bremerton, WA 98311-8330 |
Second Address | Bremerton, WA 98311-8330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2011 |
Last Update Date | 09/11/2011 |