Healthcare Provider Details

I. General information

NPI: 1073089199
Provider Name (Legal Business Name): PAUL SCARBERRY LMHC-A, SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 160TH ST S STE 101
SPANAWAY WA
98387-8508
US

IV. Provider business mailing address

PO BOX 382
ELBE WA
98330-0382
US

V. Phone/Fax

Practice location:
  • Phone: 253-904-6038
  • Fax: 253-409-2622
Mailing address:
  • Phone: 253-878-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61300281
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61508522
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: