Provider Demographics
NPI:1346788650
Name:BAUTISTA, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2334
Mailing Address - Country:US
Mailing Address - Phone:509-469-9366
Mailing Address - Fax:509-469-9926
Practice Address - Street 1:315 N 2ND ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2334
Practice Address - Country:US
Practice Address - Phone:509-469-9366
Practice Address - Fax:509-469-9926
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61033188175T00000X
WACP60820633101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist