Provider Demographics
NPI:1043794340
Name:PELOSO III, JOSEPH CHARLES (CP 61341135)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:PELOSO III
Suffix:
Gender:M
Credentials:CP 61341135
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3609
Mailing Address - Country:US
Mailing Address - Phone:509-570-7247
Mailing Address - Fax:509-982-8989
Practice Address - Street 1:105 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3609
Practice Address - Country:US
Practice Address - Phone:509-570-7247
Practice Address - Fax:509-982-8989
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61341135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2123053Medicaid