Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 00053198 | WA |
NPI | 1578754917 |
---|---|
Provider Name | Mary L. Flores |
First Address | Yakima, WA 98901-2470 |
Second Address | Yakima, WA 98901-2470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 08/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00053198 | REGISTERED COUNSELOR (01) | WA |