Benjawan Moolkeo Irwin, MC61356988
Individual provider Active NPI Mental Health Counselor · Spangle, WA
NPI 1831894443 · NPPES record last updated Apr 3, 2023
Key facts
- NPI
- 1831894443
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- MC61356988 (WA)
- Practice address
- 3025 E Spangle Waverly Rd # House19
Spangle, WA 99031-9703 - Phone
- (423) 240-5654
- NPI assigned
- Apr 3, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC61356988 | WA | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC61356988 | WA | Yes |
Addresses
Primary practice location
3025 E Spangle Waverly Rd # House19
Spangle, WA 99031-9703
Mailing address
3025 E Spangle Waverly Rd
Spangle, WA 99031-9703
Phone (423) 240-5654
Other providers in Spangle, WA
- Timari D. Brower
- Marvin Richard Gee
- Stephanie Gladding
- Henson SLP PLLC
- Gloria Ann Kelley
- Liberty School District
- Marvin R. Gee, D.D.S., P.S.
- Dakota Purvis
- Danette Rivera
All providers in Spangle, WA · Mental Health Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.