Jared Scott Detrolio

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CG60867653 Issued in WA

Practice address

840 E Plum St
Moses Lake, WA 98837-1874

Phone

(509) 765-9239

Fax

(509) 765-4124

NPI assigned

Oct 15, 2018

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cityview

  • Assisted Living Facility (Mental Illness)
  • Moses Lake, WA
  • NPI 1952668808
  NPD (past)
• County of Grant

  • Mental Health Counselor
  • Moses Lake, WA
  • NPI 1689677833
  NPD (past)
• Grant County Health District

  • Public Health or Welfare Agency
  • Moses Lake, WA
  • NPI 1295915247
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 15, 2018.

{
    "created_epoch": "1539561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1982170122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 E PLUM ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371874",
            "telephone_number": "509-765-9239",
            "fax_number": "509-765-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E PLUM ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371874",
            "telephone_number": "509-765-9239",
            "fax_number": "509-765-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETROLIO",
        "first_name": "JARED",
        "middle_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-15",
        "last_updated": "2018-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG60867653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert George Deichert II, MD
• Conrado Deleon, M.D.
• Irene G Deleon, MASSAGE THERAPIST
• Tiffany Deleon, AA
• Tabatha Delong
• Tari Ann Devaney, RDH
• Kris Dexter, DC
• Diamond Psychology LLC
• Isabel Diaz
• Magaly Diego, COTA/L

• All providers in Moses Lake, WA
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.