MEDICARE: LORETTA 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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	PLC8853	LA

General Provider Information

NPI Number	:	1790142842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA WASHINGTON

Provider Business Mailing Address
First Line	:	1417 W MORRIS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12090 S HARRELLS FERRY RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2470
Country	:	US
Telephone Number	:	225-289-6891
Fax Number	:	225-289-4887

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	06/04/2024

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Directions to “ LORETTA WASHINGTON ” Practice Location

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