| Doctor Name: | MR. BENJAMIN THEODORE DESCOTEAUX |
| NPI Number: | 1255440376 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED. |
| License Number: | CP00001300 |
| Business Practice Address: | 1007 Koala Ave Omak, WA - 988419247 |
| Business Phone Number: | 5098266191 |
| Business Fax Number: | 5098268560 |
| Mailing Address: | 1007 Koala Ave, OMAK |
| State: | WA |
| Postal Code: | 988419247 |
| Phone Number: | 5098266191 |
| Fax Number: | 5098268560 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 11/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CP00001300 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |