MEDICARE: IG THERAPY SERVICES

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	MC60219702	WA
2	101YP2500X	Professional Counselor	MC60219702	WA
3	101YM0800X	Mental Health Counselor	MC60219702	WA

General Provider Information

NPI Number	:	1053795302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IG THERAPY SERVICES

Provider Business Mailing Address
First Line	:	22626 NE INGLEWOOD HILL RD APT 737
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-5009
Country	:	US
Telephone Number	:	425-985-2134
Fax Number	:

Provider Business Practice Location Address
First Line	:	22626 NE INGLEWOOD HILL RD APT 737
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-5009
Country	:	US
Telephone Number	:	425-985-2134
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ESPERANZA IVONNE GARIBAY
Credential	:	LMHCA,MHP,EMMHS,CMHS
Telephone Number	:	425-985-2134

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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Directions to “IG THERAPY SERVICES ” Practice Location

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