Healthcare Provider Details

I. General information

NPI: 1588833495
Provider Name (Legal Business Name): GARY G MCLACHLAN LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13712 NE 20TH AVE STE A
VANCOUVER WA
98686-2702
US

IV. Provider business mailing address

13712 NE 20TH AVE STE A
VANCOUVER WA
98686-2702
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-5944
  • Fax: 360-574-6430
Mailing address:
  • Phone: 360-574-5944
  • Fax: 360-574-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018102
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: