Gary Clayton Isham, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00005949 Issued in WA

Practice address

17337 Reservation Rd
La Conner, WA 98257-8802

Phone

(360) 466-1024

NPI assigned

Sep 26, 2008

Last updated

Oct 20, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413763200000",
    "number": "1114177169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17500 S SKYRIDGE DR",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982747768",
            "telephone_number": "425-501-6257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17337 RESERVATION RD",
            "city": "LA CONNER",
            "state": "WA",
            "postal_code": "982578802",
            "telephone_number": "360-466-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHAM",
        "first_name": "GARY",
        "middle_name": "CLAYTON",
        "name_prefix": "Mr.",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-26",
        "last_updated": "2014-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00005949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199286",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marianne Haworth, M.T.
• Teylor Hendricks, ARNP, FNP, PMHNP
• Rachael R Hogan, DDS
• Tamara M Holmes, RDH
• Internal Medicine Consultants NW PS
• Justin Iwasaki, MD
• Sabrina James, MSW
• Lauren B Jaye, CNM
• Alicia Jenkins, PTA
• John K Fischer DDS PS

• Addiction (Substance Use Disorder) Counselor in La Conner, WA
• Providers in La Conner, 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 Oct 20, 2014; 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.