Healthcare Provider Details

I. General information

NPI: 1245904259
Provider Name (Legal Business Name): CARLOS BRANDON FLORES JUAREZ LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N CHELAN AVE STE A7
WENATCHEE WA
98801-6622
US

IV. Provider business mailing address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-8711
  • Fax:
Mailing address:
  • Phone: 509-663-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC.70102109
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: