MEDICARE: MRS. VANESSA VERONICA VILLAVICENCIO MA, LMHC

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	101YM0800X	Mental Health Counselor	LH00007024	WA

General Provider Information

NPI Number	:	1184813354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA VERONICA VILLAVICENCIO MA, LMHC

Provider Business Mailing Address
First Line	:	20301 19TH AVE NE
Second Line	:	SUITE 421
City	:	SHORELINE
State	:	WA
Zip	:	98155-1285
Country	:	US
Telephone Number	:	206-579-0585
Fax Number	:

Provider Business Practice Location Address
First Line	:	20102 CEDAR VALLEY RD
Second Line	:	SUITE 107
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-6333
Country	:	US
Telephone Number	:	206-579-0585
Fax Number	:

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

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	11/06/2007

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