OZARK GORE (NPI# 1750916086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750916086 |
| Entity Type | Individual |
| Full Name | OZARK GORE |
| Practice Address |
4804 Lacey Blvd Se Ste A Lacey WA 98503-5733 |
| Mailing Address |
6703 Oakbrook Ct Se Olympia WA 98513-5672 |
| Practice Telephone | 3607995782 |
| Mailing Telephone | 8082144948 |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
4804 LACEY BLVD SE STE A |
| City | LACEY |
| State | WA |
| Zip Code | 98503-5733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306004775 | Pathways Mental Health Services | Clinic/Center | 4804 Lacey Blvd Se Ste A, Suite C-3, Lacey, WA 98503-5733 | 2008-06-01 |
| 1255970554 | Elaine Vaughn | Counselor | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2020-01-03 |
| 1649830647 | Jeremy Craig Bolden | Social Worker | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2019-06-20 |
| 1821555111 | Katherine Eleanor Parker | Marriage & Family Therapist | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2019-02-22 |
| 1053822502 | Megan E Plascencia | Counselor | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2017-10-23 |
| 1023441920 | Diana Carlson | Counselor | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2013-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457838989 | Michele Nordgren Bourque | Psychologist | 4329 Concordia Lane Se, Lacey, WA 98503 | 2018-07-26 |
| 1831638675 | Trevor John Marum | Chiropractor | 3945 8th Ave Se, Lacey, WA 98503 | 2017-02-13 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1144683616 | Millenda Thomas | Registered Nurse | 1233 Firpark Dr. S.e., Lacey, WA 98503 | 2016-04-01 |
| 1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
| 1437576196 | Candy Nelson | Registered Nurse | 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 | 2014-03-19 |
| 1134563919 | Alvin Fitzgerald | Pharmacist | 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 | 2013-04-23 |
| 1518200724 | Katherine Mary Marsh | Psychologist | 5191 Corporate Center Court Se, Lacey, WA 98503 | 2013-04-05 |
| 1740530906 | Leanna Marie Mcbroom | Massage Therapist | 1608 Diamond Loop Se, Lacey, WA 98503 | 2012-09-14 |
| 1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
| Find all providers in zip 98503 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710411830 | Rickey L Jones | Psychologist | 5523 E Commerce Ave, Spokane, WA 99212-1306 | 2017-04-14 |
| 1851849855 | Yvonne Lynn Prouty | Psychologist | 1960 Thompson Dr, Sedro Woolley, WA 98284-5007 | 2016-09-19 |
| 1205088689 | Diedra L Clay | Psychologist | 2800 E Madison St Ste 320, Seattle, WA 98112-4871 | 2008-10-16 |
| 1659521912 | Wayne E Carr | Psychologist | 7800 N E Bothell Way, Suite 155 B, Kenmore, WA 98028 | 2008-09-23 |
| 1104024348 | Providence Health & Service Washington | Psychologist | 218-a Main Street, Morton, WA 98356-0000 | 2007-07-10 |
| 1245438738 | Providence Health & Service Washington | Psychologist | 1322 Commerce Ave, Longview, WA 98632-3718 | 2007-07-05 |
| 1245208404 | James William Ethier | Psychologist | 238 N. Chelan Ave., Wenatchee, WA 98801-2105 | 2006-03-14 |
| 1689272395 | Kathryn Staats | Psychologist | 1016 Commercial St, Raymond, WA 98577-2631 | 2020-10-14 |
| 1992315519 | Christine Borland | Psychologist | 5929 Westgate Blvd Ste A, Tacoma, WA 98406-2567 | 2020-08-07 |
| 1740826502 | Angela Y Yoon | Psychologist | 8811 S Tacoma Way Ste 106, Lakewood, WA 98499-4595 | 2019-11-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.