MEDICARE: ESMERALDA G LYBRAND CDP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00005948	WA

General Provider Information

NPI Number	:	1588710115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESMERALDA G LYBRAND CDP

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:	206-764-0112
Fax Number	:	206-764-0489

Provider Business Practice Location Address
First Line	:	409 CUSTER WAY SE
Second Line	:	SUITE C
City	:	TUMWATER
State	:	WA
Zip	:	98501-3350
Country	:	US
Telephone Number	:	360-570-8016
Fax Number	:	360-570-8275

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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