Healthcare Provider Details

I. General information

NPI: 1053033753
Provider Name (Legal Business Name): KIRA JEROME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 N 26TH ST STE B
TACOMA WA
98407-2406
US

IV. Provider business mailing address

5702 N 26TH ST STE B
TACOMA WA
98407-2406
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-1216
  • Fax: 253-265-4950
Mailing address:
  • Phone: 253-292-1216
  • Fax: 253-265-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.LF.70086376
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: