Healthcare Provider Details

I. General information

NPI: 1578754917
Provider Name (Legal Business Name): MARY L. FLORES CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S 3RD ST
YAKIMA WA
98901-2875
US

IV. Provider business mailing address

402 N 4TH ST SUITE 300
YAKIMA WA
98901-2470
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-1800
  • Fax:
Mailing address:
  • Phone: 509-453-9387
  • Fax: 509-453-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number00053198
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: