Provider Demographics
NPI:1427508597
Name:KEWIN, SEAN PAUL MICHAEL (MA, LAC, NCC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PAUL MICHAEL
Last Name:KEWIN
Suffix:
Gender:M
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 W SAINT MARYS RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2654
Mailing Address - Country:US
Mailing Address - Phone:520-965-7355
Mailing Address - Fax:
Practice Address - Street 1:1773 W SAINT MARYS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2654
Practice Address - Country:US
Practice Address - Phone:520-965-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-14330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor