Doctor Name: | MR. GORDON LEWIS BORDEAUX |
NPI Number: | 1285804328 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | CP00003406 |
Business Practice Address: | 1007 Koala Ave Omak, WA - 988419247 |
Business Phone Number: | 5098266191 |
Business Fax Number: | 5098268416 |
Mailing Address: | 1007 Koala Drive, OMAK |
State: | WA |
Postal Code: | 98841 |
Phone Number: | 5098266191 |
Fax Number: | 5098268416 |
NPI Enumeration Date: | 03/05/2008 |
NPI Last Update Date: | 03/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CP00003406 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |