Provider Demographics
NPI:1912135757
Name:WASHINGTON, MYRANA
Entity Type:Individual
Prefix:
First Name:MYRANA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 PLEASANT RUN RD
Mailing Address - Street 2:217
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6709
Mailing Address - Country:US
Mailing Address - Phone:405-886-0390
Mailing Address - Fax:
Practice Address - Street 1:4125 PLEASANT RUN RD
Practice Address - Street 2:217
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6709
Practice Address - Country:US
Practice Address - Phone:405-886-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22482104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker