| |
1812 S J St Ste 220 Tacoma WA 98405-4964 | |
(253) 426-6762 | |
(253) 426-6224 |
Full Name | |
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Speciality | Psychologist - Clinical |
Location | 1812 S J St, Tacoma, Washington |
Authorized Official Name and Position | Mike Fitzgerald (VP FINANCIAL OPERATIONS) |
Authorized Official Contact | 2535524105 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1812 S J St Ste 220 Tacoma WA 98405-4964 Ph: (253) 426-6762 | 1812 S J St Ste 220 Tacoma WA 98405-4964 Ph: (253) 426-6762 |
NPI Number | 1225224223 |
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Provider Enumeration Date | 09/24/2007 |
Last Update Date | 02/05/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225224223 | NPI | - | NPPES |
0224795 | Other | WA | STATE L&I |
7139231 | Medicaid | WA | |
8907052 | Other | WA | STATE CRIME VICTIMS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (Washington) | Primary |
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