Provider Demographics
NPI:1356311856
Name:HIRES, PHILIP GREGG (MSSW, LSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GREGG
Last Name:HIRES
Suffix:
Gender:M
Credentials:MSSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8051
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-0051
Mailing Address - Country:US
Mailing Address - Phone:509-469-1903
Mailing Address - Fax:509-469-1905
Practice Address - Street 1:134 FLYING H LOOP
Practice Address - Street 2:
Practice Address - City:NACHES
Practice Address - State:WA
Practice Address - Zip Code:98937-9168
Practice Address - Country:US
Practice Address - Phone:509-658-2992
Practice Address - Fax:509-697-4712
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8852315Medicare PIN