Most Relevant Information
Provider Data
| NPI Number: | 1003472440 |
| Provider Name: | TOMAS D MINO PENA CDPT60922995 |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 1376696096 |
Most Important Dates
| Enumeration Date: | 05/10/2019 |
| Last Updated: | 05/24/2019 |
Provider Practice Location
151 N MARKET BLVD STE C
CHEHALIS
WA
985322677
Practice Location Phone/Fax
| Phone: | 3609480203 |
| Fax: | 3602626703 |
Provider Mailing Location
121 NW CHEHALIS AVE
CHEHALIS
WA
985322010
Provider Mailing Phone/Fax
| Phone: | 3609480203 |
| Fax: | 3602626703 |