Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 14-09-02 | OR |
NPI | 1003278599 |
---|---|
Provider Name | Ms. Amy Cloudt |
First Address | Grants Pass, OR 97526-2843 |
Second Address | Grants Pass, OR 97526-2078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 23/03/2016 |