Basic Information
| Provider Information | |||||||||
| NPI: | 1548719685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INFANTE | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 N WEHE AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993014253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095462589 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993015794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095479000 | ||||||||
| FaxNumber: | 5095428766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2016 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.