Basic Information
| Provider Information | |||||||||
| NPI: | 1528585718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROURKE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | IV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3318 BRIDGEPORT WAY W STE C1 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033329969 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3318 BRIDGEPORT WAY W STE C1 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033329969 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2017 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MP60886693 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.