Provider Demographics
NPI:1770153264
Name:WASHINGTON, PRENTISS JEROME (QMHP)
Entity type:Individual
Prefix:MR
First Name:PRENTISS
Middle Name:JEROME
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3428
Mailing Address - Country:US
Mailing Address - Phone:281-210-1500
Mailing Address - Fax:
Practice Address - Street 1:2929 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3428
Practice Address - Country:US
Practice Address - Phone:281-210-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician