Ethan D Gonzales, Recovery Coach
Peer Specialist in Vancouver, WA. Individual provider (NPI-1).
NPI number1982187498
StatusActive
Last updated in NPPESOct 21, 2020
Details
- NPI
- 1982187498
- Entity type
- Individual (NPI-1)
- Name
- Mr. Ethan D Gonzales
- Credential
- Recovery Coach
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 11, 2018
- Certification date
- Oct 21, 2020
- Last updated
- Oct 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | – | WA | Yes |
Practice location
1601 E 4th Plain Blvd Bldg 17Vancouver, WA 98661-3717
Phone 360-397-8246
Mailing address
1601 E 4th Plain Blvd Bldg 17Vancouver, WA 98661-3717
Phone 360-397-8246
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