=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538430160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN LETITIA BIRECH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2012
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1949 S STATE ST CHILDREN & FAMILY SERVICES
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-983-6329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7236 COLTER AVE UNIT B
-----------------------------------------------------
City | JOINT BASE LEWIS MCCHORD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98433-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-415-8552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 51830
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------