MEDICARE: ROBERT ESPIAU MFTA, CADC II, CDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	03-03-54	OR
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	60456771	WA
3	106H00000X	Marriage & Family Therapist	MG 60472495	WA

General Provider Information

NPI Number	:	1083023527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ESPIAU MFTA, CADC II, CDP

Provider Business Mailing Address
First Line	:	1004 E ERMINA AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207-2540
Country	:	US
Telephone Number	:	805-266-3734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 N WASHINGTON ST
Second Line	:	SUITE 206
City	:	SPOKANE
State	:	WA
Zip	:	99201-2403
Country	:	US
Telephone Number	:	509-209-9486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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