Healthcare Provider Details

I. General information

NPI: 1538370960
Provider Name (Legal Business Name): GARY SCOTT SIMS S.U.D.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 508
OAKVILLE WA
98568-0508
US

IV. Provider business mailing address

PO BOX 508
OAKVILLE WA
98568-0508
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-1661
  • Fax: 707-274-4628
Mailing address:
  • Phone: 360-360-7091
  • Fax: 707-274-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00001819
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: