Provider Demographics
NPI:1821654930
Name:CARRASCO, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:CHERIE COX
Other - Last Name:MCCRARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3941B HIGHWAY 292
Mailing Address - Street 2:
Mailing Address - City:LOON LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99148-9790
Mailing Address - Country:US
Mailing Address - Phone:509-991-0290
Mailing Address - Fax:
Practice Address - Street 1:3941B HIGHWAY 292
Practice Address - Street 2:
Practice Address - City:LOON LAKE
Practice Address - State:WA
Practice Address - Zip Code:99148-9790
Practice Address - Country:US
Practice Address - Phone:509-991-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61008600101YM0800X
WACG60965335390200000X
WALH61344075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program