MEDICARE: GANITA MUSA

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	101Y00000X	Counselor	LW61004812	WA

General Provider Information

NPI Number	:	1720457864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GANITA MUSA

Provider Business Mailing Address
First Line	:	4501 15TH AVE S STE 103
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1874
Country	:	US
Telephone Number	:	253-458-4281
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 15TH AVE S STE 103
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1874
Country	:	US
Telephone Number	:	253-458-4281
Fax Number	:

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

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	02/15/2021

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Directions to “ GANITA MUSA ” Practice Location

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