Healthcare Provider Details

I. General information

NPI: 1679487706
Provider Name (Legal Business Name): MAEUM PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE # 7004
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

522 W RIVERSIDE AVE # 7004
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 952-999-3130
  • Fax:
Mailing address:
  • Phone: 952-999-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GRACE KIM
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 952-999-3130