Provider Demographics
NPI:1821393570
Name:WASHINGTON, FRED (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-9714
Mailing Address - Country:US
Mailing Address - Phone:970-464-9381
Mailing Address - Fax:
Practice Address - Street 1:131 W 1ST ST
Practice Address - Street 2:
Practice Address - City:PALISADE
Practice Address - State:CO
Practice Address - Zip Code:81526-9714
Practice Address - Country:US
Practice Address - Phone:970-464-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional