Healthcare Provider Details

I. General information

NPI: 1225696933
Provider Name (Legal Business Name): MIA R PIPER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 E 8TH ST
PORT ANGELES WA
98362-6219
US

IV. Provider business mailing address

PO BOX 24029
SEATTLE WA
98124-0029
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-0999
  • Fax: 360-457-4841
Mailing address:
  • Phone: 360-565-0999
  • Fax: 360-457-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLW61505186
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61116305
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61505186
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: