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General NPI Number Information
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NPI Number | 1255835823
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Entity Type | Organization
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Legal Business Name | MATTPAL PLLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 2412 N 30TH ST STE 102
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City | TACOMA
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State | WA
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Zip | 98407-6322
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Country | US
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Telephone | 253-209-2661
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 N 30TH ST STE 102
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City | TACOMA
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State | WA
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Zip | 98407-6322
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Country | US
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Telephone | 253-209-2661
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Fax |
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Authorized Official
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Title or Position | EXECUTOR
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Name | GINA PALUMBO
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Credential |
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Telephone | 253-209-2661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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