Healthcare Provider Details

I. General information

NPI: 1225992662
Provider Name (Legal Business Name): MAYRA ARIAS FARIAS SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N MORAIN ST
KENNEWICK WA
99336-2667
US

IV. Provider business mailing address

1548 N EDISON ST APT D205
KENNEWICK WA
99336-1580
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-6900
  • Fax: 509-735-6914
Mailing address:
  • Phone: 509-735-6900
  • Fax: 509-735-6914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO770046221
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: