Provider Demographics
NPI:1235311465
Name:ISLAS, ELIAZAR
Entity Type:Individual
Prefix:
First Name:ELIAZAR
Middle Name:
Last Name:ISLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4246
Mailing Address - Country:US
Mailing Address - Phone:509-946-8778
Mailing Address - Fax:509-946-3887
Practice Address - Street 1:660 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4246
Practice Address - Country:US
Practice Address - Phone:509-946-8778
Practice Address - Fax:509-946-3887
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00024546101Y00000X
WACP00001960101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)