Provider Demographics
NPI:1790545168
Name:CARRILLO, VINCENT R III
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:R
Last Name:CARRILLO
Suffix:III
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 1:303 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-9748
Mailing Address - Country:US
Mailing Address - Phone:509-731-5851
Mailing Address - Fax:
Practice Address - Street 1:211 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1160
Practice Address - Country:US
Practice Address - Phone:509-402-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)