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General NPI Number Information
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NPI Number | 1003470006
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Entity Type | Individual
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Provider Name | GARY MARK FROST
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Gender | Male
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 915 N ELLA RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99212-3704
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Country | US
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Telephone | 509-340-7214
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Fax |
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Provider Business Mailing Address
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Address Line | 804 S LINCOLN PL APT A
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City | SPOKANE
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State | WA
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Zip | 99204-2920
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Country | US
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Telephone | 509-220-0672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00003456
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00006230
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License Number State | WA
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