Individual
VAUGHN EAGLEBEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1803 W MAXWELL AVE, SPOKANE, WA 99201-2831
(509) 325-5502
Mailing address
1803 W MAXWELL AVE, SPOKANE, WA 99201-2831
(509) 325-5502
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00005604
WA
101YM0800X
Mental Health Counselor
CP00005604
WA
Other
Enumeration date
07/20/2007
Last updated
07/20/2007
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