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General NPI Number Information
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NPI Number | 1285405522
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Entity Type | Organization
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Legal Business Name | KATIE'S WAY TACOMA, LLC
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 6704 TACOMA MALL BLVD STE 111
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City | TACOMA
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State | WA
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Zip | 98409-9001
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Country | US
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Telephone | 253-260-3460
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Fax | 253-397-3443
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Provider Business Mailing Address
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Address Line | 6704 TACOMA MALL BLVD STE 111
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City | TACOMA
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State | WA
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Zip | 98409-9001
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Country | US
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Telephone | 253-260-3460
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Fax | 253-397-3443
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | KELLY RAE JOHNSON
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Credential |
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Telephone | 785-320-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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Taxonomy #6
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #8
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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Taxonomy #9
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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Taxonomy #10
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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Taxonomy #11
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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