MEDICARE: ALAGNA VALSESIA AMFT

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	106H00000X	Marriage & Family Therapist	MG61482365	WA

General Provider Information

NPI Number	:	1679343479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAGNA VALSESIA AMFT

Provider Business Mailing Address
First Line	:	811 S SYCAMORE LN
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-2756
Country	:	US
Telephone Number	:	208-721-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 S SYCAMORE LN
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-2756
Country	:	US
Telephone Number	:	208-721-0399
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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