Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1043829419 |
---|---|
Provider Name | Nisom Andrew Reyes Castillo |
First Address | Olympia, WA 98502-4956 |
Second Address | Olympia, WA 98506-5050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2020 |
Last Update Date | 30/07/2020 |