MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF PIERCE AND KITSAP COUNTIES

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
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1659822047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF PIERCE AND KITSAP COUNTIES

Provider Business Mailing Address
First Line	:	4717 S 19TH ST
Second Line	:	#201
City	:	TACOMA
State	:	WA
Zip	:	98405-1167
Country	:	US
Telephone Number	:	253-534-7800
Fax Number	:	253-566-9657

Provider Business Practice Location Address
First Line	:	4717 S 19TH ST
Second Line	:	#201
City	:	TACOMA
State	:	WA
Zip	:	98405-1167
Country	:	US
Telephone Number	:	253-534-7800
Fax Number	:	253-566-9657

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	ANNE PORTER
Credential	:
Telephone Number	:	253-534-7812

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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