MEDICARE: GRACIE ABANGAN

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	RC00056467	WA

General Provider Information

NPI Number	:	1740333863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIE ABANGAN

Provider Business Mailing Address
First Line	:	PO BOX 150
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-0150
Country	:	US
Telephone Number	:	509-826-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 KOALA AVE
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-9247
Country	:	US
Telephone Number	:	509-826-6191
Fax Number	:

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

Provider Enumeration Date	:	01/20/2007
Last Update Date	:	07/08/2007

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Directions to “ GRACIE ABANGAN ” Practice Location

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