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NPI Code Detail

MEDICARE: MARY GRACE PIERSON PSYCHOLOGY BA

MEDICARE: MARY GRACE PIERSON PSYCHOLOGY BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1467146894
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY GRACE PIERSON PSYCHOLOGY BA
Provider Business Mailing Address
First Line : 4526 FEDERAL AVE
Second Line :
City : EVERETT
State : WA
Zip : 98203-2132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 707 E JENKINS AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1318
Country : US
Telephone Number : 440-865-9530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2023
Last Update Date : 11/12/2024

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