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Sheila Nicole Mansurov

Counselor

Behavioral Health & Social Service Providers

11415 NE 128th St Ste 100, Kirkland, WA 98034-6314

PECOS Enrollment

This provider is enrolled in PECOS as SHEILA MANSUROV.

Based on the most recent information from CMS, provider Sheila Nicole Mansurov is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1962655050
Provider Type
Individual
Full Name
Mansurov, Sheila Nicole
Credential
MA, LMHC, SOTP

Gender
Female
Sole Proprietor
No
Enumeration Date
11/3/2008
Last Updated
12/11/2014

Contact Information

Practice Location

11415 NE 128th St Ste 100, Kirkland, WA 98034-6314

(425) 298-6223

Unlisted Fax

Mailing Location

11415 NE 128th St Ste 100, Kirkland, WA 98034

(425) 298-6223

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License LH60184919 Washington
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License FC 60206027 Washington
Code 101YP2500X	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 2039799	Description Medicaid	Issuer Unlisted Washington

Sheila Nicole Mansurov

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Mccullough, Mary

Carlson, Tracie Lynn

Shelley, Selena B

West, April

Weidell, Nicholas

Morales, Cynthia Jean

Ho, Deanna Mei

Gorham, Barbara Josephine

Neef, Amanda

Shuman, Maurice Brandon