Miguel Angel Bautista, CO61191490
Counselor, Addiction (Substance Use Disorder) in Yakima, WA. Individual provider (NPI-1).
NPI number1033856414
StatusActive
Last updated in NPPESMay 17, 2022
Details
- NPI
- 1033856414
- Entity type
- Individual (NPI-1)
- Name
- Miguel Angel Bautista
- Credential
- CO61191490
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 17, 2022
- Certification date
- May 2, 2022
- Last updated
- May 17, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
2280 Sr 821Yakima, WA 98901-1017
Phone 509-307-6858
Mailing address
2280 Sr 821Yakima, WA 98901-1017
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