Healthcare Provider Details

I. General information

NPI: 1598948481
Provider Name (Legal Business Name): PAUL D. MUNSON BA, RC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY
SEATTLE WA
98122-7302
US

IV. Provider business mailing address

325 9TH AVE BOX 359797
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9690
  • Fax: 206-744-9920
Mailing address:
  • Phone: 206-744-9690
  • Fax: 206-744-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00017782
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRC00017782
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: