Individual
JONATHAN SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
149 S MAIN ST, PHOENIX, OR 97535-6631
(541) 535-4133
Mailing address
2644 CARR ST, WHITE CITY, OR 97503-1104
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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