=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487778700
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY ALENE KIRKPATRICK MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 HARVEY RD STE E
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-4247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-833-7748
-----------------------------------------------------
Fax | 253-939-1069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 820 HARVEY RD STE E
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98002-4247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-833-7748
-----------------------------------------------------
Fax | 253-939-1069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LM00007186
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------