Mitchell Andrew Cueba Jr., CO61037829

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO61037829 Issued in WA

Practice address

20 Gunnyon Rd.
Toppenish, WA 98948-9894

Phone

(509) 865-5121

Fax

(509) 865-4333

NPI assigned

Mar 25, 2020

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

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": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1497382782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 HIGHLAND DR",
            "city": "BUENA",
            "state": "WA",
            "postal_code": "989210139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 GUNNYON RD.",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989489894",
            "telephone_number": "509-865-5121",
            "fax_number": "509-865-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUEBA",
        "first_name": "MITCHELL",
        "middle_name": "ANDREW",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CO61037829",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-25",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61037829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "91-0755984",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn S Conquest, FNP
• Katrina Lynn Conrad, MD
• Copeland Chiropractic PLLC
• County of Yakima Toppenish School District 202 (Toppenish School District 202)
• Robert Palmer Cox III, MA LMFT
• Anil Kumar Danda
• Peter Dang, DMD
• Minh Duy Dao, MD
• Elisabeth Davis
• Kathleen Kingsford Davis, M.D.

• Addiction (Substance Use Disorder) Counselor in Toppenish, WA
• Providers in Toppenish, 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 Sep 21, 2022; 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.