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General NPI Number Information
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NPI Number | 1407213721
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Entity Type | Organization
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Legal Business Name | MARILYN BOYLE MA MTS LLC
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Dates
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Enumeration Date | 01/16/2016
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 917 PACIFIC AVE SUITE 406
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City | TACOMA
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State | WA
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Zip | 98402-4446
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Country | US
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Telephone | 253-572-7926
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Fax |
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Provider Business Mailing Address
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Address Line | 917 PACIFIC AVE SUITE 406
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City | TACOMA
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State | WA
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Zip | 98402-4446
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Country | US
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Telephone | 253-572-7926
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Fax |
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Authorized Official
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Title or Position | OWNER/LMHC
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Name | MS. MARILYN ELAINE BOYLE
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Credential |
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Telephone | 253-572-7926
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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 | LH00004667
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License Number State | WA
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