Individual
RYAN LORENZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDPT
Contact information
Practice address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
Mailing address
404 W MAIN ST, KELSO, WA 98626-1118
(360) 423-2806
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60932825
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO60932825
DEPARTMENT OF HEALTH
WA
Enumeration date
02/26/2019
Last updated
02/26/2019
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