Provider Demographics
NPI:1588288658
Name:OPATZ, SKYLAR O (SUDPT)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:O
Last Name:OPATZ
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W 6TH AVE PH 3C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2745
Mailing Address - Country:US
Mailing Address - Phone:509-218-9810
Mailing Address - Fax:
Practice Address - Street 1:508 W 6TH AVE PH 3C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2745
Practice Address - Country:US
Practice Address - Phone:509-218-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61184413101YA0400X
WALH61513090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid