Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | CG60571319 | WA |
NPI | 1003236563 |
---|---|
Provider Name | Chloe Wyen |
First Address | Longview, WA 98632 |
Second Address | Longview, WA 98632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 09/06/2015 |