Individual
MAYRA BUSTAMANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CO61586344
Contact information
Practice address
613 SUPERIOR LN, YAKIMA, WA 98902-1623
(509) 853-4151
Mailing address
613 SUPERIOR LN, YAKIMA, WA 98902-1623
(509) 853-4151
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61586344
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91-0755984
—
WA
Enumeration date
12/03/2024
Last updated
12/03/2024
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