MEDICARE: DEBRA EVELYN WASHINGTON

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427445402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA EVELYN WASHINGTON

Provider Business Mailing Address
First Line	:	5616 GRANDMOTHER HAT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6467
Country	:	US
Telephone Number	:	205-722-4485
Fax Number	:

Provider Business Practice Location Address
First Line	:	5616 GRANDMOTHER HAT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6467
Country	:	US
Telephone Number	:	205-722-4485
Fax Number	:

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

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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Directions to “ DEBRA EVELYN WASHINGTON ” Practice Location

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