Provider Demographics
NPI:1912472556
Name:FLORES, JOSUE M I (CDPT)
Entity Type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:M
Last Name:FLORES
Suffix:I
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 MERIDIAN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5575
Mailing Address - Country:US
Mailing Address - Phone:360-922-3030
Mailing Address - Fax:
Practice Address - Street 1:4120 MERIDIAN ST STE 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5575
Practice Address - Country:US
Practice Address - Phone:360-922-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
WACO60823351101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)