Provider Demographics
NPI:1952881161
Name:GAUTREAUX, ARIN COLE (MSW, LICSWA, BS, CPC)
Entity Type:Individual
Prefix:
First Name:ARIN
Middle Name:COLE
Last Name:GAUTREAUX
Suffix:
Gender:M
Credentials:MSW, LICSWA, BS, CPC
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:ERIN
Other - Last Name:GAUTREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, CPC
Mailing Address - Street 1:673 WOODLAND SQUARE LOOP SE STE 330
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1066
Mailing Address - Country:US
Mailing Address - Phone:888-364-5977
Mailing Address - Fax:360-628-5240
Practice Address - Street 1:673 WOODLAND SQUARE LOOP SE STE 330
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98503-1066
Practice Address - Country:US
Practice Address - Phone:888-364-5977
Practice Address - Fax:360-628-5240
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG6084461175T00000X
WASC613524701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC61352470Medicaid
WACG60844661Medicaid