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1114384039
GARY PETERSON
WHITE CITY, OR
NPI
1114384039
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2016-01-22
Last Update Date
2016-01-22
Business Address
-- GARY PETERSON CADC 2
8495 CRATER LAKE HWY
WHITE CITY, OR 97503-3011
Phone number: 541-826-2111
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Mailing Address
-- GARY PETERSON CADC 2
8495 CRATER LAKE HWY
WHITE CITY, OR 97503-3011
Phone number: 541-826-2111
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