Healthcare Provider Details

I. General information

NPI: 1548773062
Provider Name (Legal Business Name): JAZZ LAMAR WASHINGTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD STE 420
ARLINGTON TX
76011-1315
US

IV. Provider business mailing address

1112 E COPELAND RD STE 420
ARLINGTON TX
76011-1315
US

V. Phone/Fax

Practice location:
  • Phone: 817-631-0976
  • Fax:
Mailing address:
  • Phone: 817-631-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCOU.7523
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number89459
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: