MEDICARE: JUANA IRIS MARQUEZ-VILLEGAS MENTAL HEALTH COUNSE

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	101YM0800X	Mental Health Counselor
2	101YS0200X	School Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000	OTHER		00000

General Provider Information

NPI Number	:	1427647916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA IRIS MARQUEZ-VILLEGAS MENTAL HEALTH COUNSE

Provider Business Mailing Address
First Line	:	2201 18TH ST NW # NA
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-1812
Country	:	US
Telephone Number	:	202-673-7308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 18TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-1812
Country	:	US
Telephone Number	:	202-673-7308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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