Provider Information for 1588062475
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Mr. JOSEPH KIM MYRICK LICSWA
Sex: Male
NPI: 1588062475
Last Updated: 2016-09-02
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1588062475 | ||||||||||||
| Enumeration Date | 2014-12-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5005 PACIFIC HWY E STE 20 FIFE, WA 98424-2647 United States Phone: 253-922-6522 | Fax:253-922-6955 | ||||||||||||
| Primary Practice Address | 325 PIONEER AVE PUYALLUP, WA 98372 United States Phone: 253-697-8400 | Fax:253-697-3730 | ||||||||||||
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