MEDICARE: RAFAEL YAMEL SALAS LMSW

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	1041C0700X	Clinical Social Worker	133904001	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1399589238	OTHER	TX	HUMANA-TRICARE

General Provider Information

NPI Number	:	1942946066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL YAMEL SALAS LMSW

Provider Business Mailing Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-3869
Fax Number	:	253-968-3219

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-3869
Fax Number	:	253-968-3219

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	03/05/2026

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