Healthcare Provider Details

I. General information

NPI: 1235898966
Provider Name (Legal Business Name): ALMA YURI ESCARENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N ELM ST
GRANDVIEW WA
98930-1009
US

IV. Provider business mailing address

106 N ELM ST
GRANDVIEW WA
98930-1009
US

V. Phone/Fax

Practice location:
  • Phone: 509-305-1542
  • Fax:
Mailing address:
  • Phone: 480-825-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBHA.FS.61095260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: