Individual
JOHN LANELL FITZPATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC, CPC
Contact information
Practice address
1408 12TH AVE, LONGVIEW, WA 98632-3822
(360) 998-3050
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632-8455
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
WA
171M00000X
Case Manager/Care Coordinator
—
WA
175T00000X
Peer Specialist
Primary
CG61163067
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2176426
—
WA
Enumeration date
02/25/2021
Last updated
01/06/2022
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