MEDICARE: PARVEEN ABDUL MED LMHC CDP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00000110	WA
2	101YM0800X	Mental Health Counselor	LH00008923	WA

General Provider Information

NPI Number	:	1003973926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARVEEN ABDUL MED LMHC CDP

Provider Business Mailing Address
First Line	:	PO BOX 959
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98907-0959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 KELLY PL STE 234
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-8607
Country	:	US
Telephone Number	:	509-575-4084
Fax Number	:	509-524-2920

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	04/22/2022

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