MEDICARE: NAOMI CARRASCO

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	MC61008600	WA
2	390200000X	Student in an Organized Health Care Education/Training Program	CG60965335	WA
3	101YM0800X	Mental Health Counselor	LH61344075	WA

General Provider Information

NPI Number	:	1821654930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI CARRASCO

Provider Business Mailing Address
First Line	:	3941B HIGHWAY 292
Second Line	:
City	:	LOON LAKE
State	:	WA
Zip	:	99148-9790
Country	:	US
Telephone Number	:	509-991-0290
Fax Number	:

Provider Business Practice Location Address
First Line	:	3941B HIGHWAY 292
Second Line	:
City	:	LOON LAKE
State	:	WA
Zip	:	99148-9790
Country	:	US
Telephone Number	:	509-991-0290
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2024

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Directions to “ NAOMI CARRASCO ” Practice Location

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