MEDICARE: DAISY S VERGARA MS, NCC, 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	MHC-179	HI
2	101YP2500X	Professional Counselor	65961	TX
3	101YM0800X	Mental Health Counselor	LH-60428413	WA

General Provider Information

NPI Number	:	1316118003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY S VERGARA MS, NCC, LMHC

Provider Business Mailing Address
First Line	:	23515 NE NOVELTY HILL RD STE B221-159
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98053-1996
Country	:	US
Telephone Number	:	425-686-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	22500 SE 64TH PL STE G-150
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8111
Country	:	US
Telephone Number	:	425-686-9509
Fax Number	:

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

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	07/21/2022

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