MEDICARE: MR. JAZZ LAMAR WASHINGTON LPC

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	101YP2500X	Professional Counselor	COU.7523	SC
2	101YP2500X	Professional Counselor	89459	TX

General Provider Information

NPI Number	:	1548773062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAZZ LAMAR WASHINGTON LPC

Provider Business Mailing Address
First Line	:	1112 E COPELAND RD STE 420
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-1315
Country	:	US
Telephone Number	:	817-631-0976
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 E COPELAND RD STE 420
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-1315
Country	:	US
Telephone Number	:	817-631-0976
Fax Number	:

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

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	08/27/2024

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