Individual
GARY COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1128 NW HARRIMAN ST, BEND, OR 97703-1947
(541) 777-0755
Mailing address
78 CENTENNIAL LOOP STE A, EUGENE, OR 97401-7900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
OR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/02/2016
Last updated
05/16/2023
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