Tomas D Mino Pena, CDPT60922995

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1376696096 Issued in WA

Practice address

151 N Market Blvd Ste C
Chehalis, WA 98532-2677

Phone

(360) 948-0203

Fax

(360) 262-6703

NPI assigned

May 10, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eugenia Center

  • Substance Abuse Rehabilitation Facility
  • Chehalis, WA
  • NPI 1376696096
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558656000000",
    "number": "1003472440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 NW CHEHALIS AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322010",
            "telephone_number": "360-948-0203",
            "fax_number": "360-262-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N MARKET BLVD STE C",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322677",
            "telephone_number": "360-948-0203",
            "fax_number": "360-262-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINO PENA",
        "first_name": "TOMAS",
        "middle_name": "D",
        "credential": "CDPT60922995",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-10",
        "last_updated": "2019-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "1376696096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Gene Middleton, OTA
• Brian Miller, M.S.
• Donald Rex Miller, MD
• Shayla Miller
• Randi Mills
• Kari L Mitchell
• Shirley J Mitchell
• Faith Mmborothi, ARNP
• Moeckel Chiropractic, P.S.
• Scott Moeckel, D.C.

• Addiction (Substance Use Disorder) Counselor in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.