MEDICARE: YECENIA LICETT GIRON HARRIS LMHC, CMHS, 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
1	101YM0800X	Mental Health Counselor		WA
2	101YM0800X	Mental Health Counselor	LH60733616	WA

General Provider Information

NPI Number	:	1275940587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YECENIA LICETT GIRON HARRIS LMHC, CMHS, EMMHS

Provider Business Mailing Address
First Line	:	4501 15TH AVE S STE 103
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1874
Country	:	US
Telephone Number	:	253-256-2492
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 15TH AVE S STE 103
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1874
Country	:	US
Telephone Number	:	253-256-2492
Fax Number	:

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

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	01/27/2022

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