Healthcare Provider Details

I. General information

NPI: 1720557218
Provider Name (Legal Business Name): GREY WILTSHIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 NE 7TH AVE STE 403
VANCOUVER WA
98685-4548
US

IV. Provider business mailing address

10000 NE 7TH AVE STE 403
VANCOUVER WA
98685-4548
US

V. Phone/Fax

Practice location:
  • Phone: 360-952-3070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61152455
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: