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NPI Code Detail

MEDICARE: TAYE DEGEFU CMHS, MHP, EMMHS

MEDICARE: TAYE DEGEFU CMHS, MHP, EMMHS
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
1101YM0800XMental Health CounselorWA

General Provider Information

NPI Number : 1033623764
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYE DEGEFU CMHS, MHP, EMMHS
Provider Business Mailing Address
First Line : 3936 S ORCAS ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-2266
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3722 S HUDSON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1920
Country : US
Telephone Number : 206-721-5542
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2017
Last Update Date : 11/16/2017

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