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1003472440
TOMAS D MINO PENA
CHEHALIS, WA
NPI
1003472440
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA 1376696096)
Enumeration Date
2019-05-10
Last Update Date
2019-05-24
Business Address
TOMAS D MINO PENA CDPT60922995
151 N MARKET BLVD STE C
CHEHALIS, WA 98532-2677
Phone number: 360-948-0203
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Mailing Address
TOMAS D MINO PENA CDPT60922995
121 NW CHEHALIS AVE
CHEHALIS, WA 98532-2010
Phone number: 360-948-0203
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