Basic Information
| Provider Information | |||||||||
| NPI: | 1245411685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLIGAN | ||||||||
| FirstName: | PHOEBE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6004 N. WESTGATE BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6004 WESTGATE BLVD | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984062503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60170219 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.