Basic Information
| Provider Information | |||||||||
| NPI: | 1588062475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYRICK | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 PACIFIC HWY E STE 20 | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984242647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539226522 | ||||||||
| FaxNumber: | 2539226955 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 PIONEER AVE | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536978400 | ||||||||
| FaxNumber: | 2536973730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2014 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00005499 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | SC60271192 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.