Healthcare Provider Details

I. General information

NPI: 1487239216
Provider Name (Legal Business Name): MAICO JOSIAH HU LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S FIFE ST STE 301
TACOMA WA
98409-7309
US

IV. Provider business mailing address

3901 S FIFE ST STE 301
TACOMA WA
98409-7309
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-5334
  • Fax: 253-584-1496
Mailing address:
  • Phone: 253-589-5334
  • Fax: 253-584-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010288
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010288
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61538818
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: