MEDICARE: NEW DAWN BEHAVIORAL INNOVATIONS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1407532054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DAWN BEHAVIORAL INNOVATIONS PLLC

Provider Business Mailing Address
First Line	:	1706 ANNA CREEK DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9036 35TH AVE SW STE B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3821
Country	:	US
Telephone Number	:	336-300-0712
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH ADEBAYO
Credential	:
Telephone Number	:	281-749-1517

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	12/28/2023

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