Most Relevant Information
Provider Data
| NPI Number: | 1003640517 |
| Provider Name: | THOMAS IZAYAH CHARLES |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/27/2024 |
| Last Updated: | 08/27/2024 |
Provider Practice Location
505 S 4TH AVE
YAKIMA
WA
989023547
Practice Location Phone/Fax
| Phone: | 5095754084 |
| Fax: |
Provider Mailing Location
PO BOX 959
YAKIMA
WA
989070959
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |