Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00003456 | WA |
Y | 101YM0800X | Mental Health Counselor | LH00006230 | WA |
NPI | 1003470006 |
---|---|
Provider Name | Gary Mark Frost |
First Address | Spokane, WA 99204-2920 |
Second Address | Spokane Valley, WA 99212-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |