Provider Demographics
NPI:1659038743
Name:ANTUNEZ, EVARISTO JESUS
Entity Type:Individual
Prefix:
First Name:EVARISTO
Middle Name:JESUS
Last Name:ANTUNEZ
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 1:58147 COLUMBIA RIVER HWY STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6229
Mailing Address - Country:US
Mailing Address - Phone:503-901-9385
Mailing Address - Fax:
Practice Address - Street 1:58147 COLUMBIA RIVER HWY STE C
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6229
Practice Address - Country:US
Practice Address - Phone:503-901-9385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)