Basic Information
| Provider Information | |||||||||
| NPI: | 1154945640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERVANTES | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 N MORAIN ST STE 1250 | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993362967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097830500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 N MORAIN ST STE 1250 | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993362967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097830500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2020 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60833022 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.