Individual
MR. JASON RAYDR-SCOTT GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDP
Contact information
Practice address
31912 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9700
(360) 297-6329
Mailing address
32020 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
(360) 297-6327
(360) 925-3897
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
60777486
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61031153
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61031153
SUDP CREDINTENTIAL
WA
Enumeration date
01/26/2019
Last updated
08/30/2022
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