Provider Demographics
NPI:1962980896
Name:FLORES, PATRICK CHARLES (LICSW, MSW, CDP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:CHARLES
Last Name:FLORES
Suffix:
Gender:M
Credentials:LICSW, MSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4114
Mailing Address - Country:US
Mailing Address - Phone:509-529-6036
Mailing Address - Fax:509-529-6038
Practice Address - Street 1:919 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4114
Practice Address - Country:US
Practice Address - Phone:509-529-6036
Practice Address - Fax:509-529-6038
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
WALW000091941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health