Basic Information
| Provider Information | |||||||||
| NPI: | 1154938041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAROCQUE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | SUDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 W GARDNER AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992011743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098501354 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3710 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992052850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093285234 | ||||||||
| FaxNumber: | 5093282358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2020 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP61334705 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 2204287 | 05 | WA | MEDICAID | 2077844 | 05 | WA | MEDICAID |