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General NPI Number Information
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NPI Number | 1588062475
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Entity Type | Individual
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Provider Name | JOSEPH KIM MYRICK LICSWA
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Gender | Male
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 325 PIONEER AVE
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City | PUYALLUP
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State | WA
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Zip | 98372
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Country | US
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Telephone | 253-697-8400
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Fax | 253-697-3730
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Provider Business Mailing Address
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Address Line | 5005 PACIFIC HWY E STE 20
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City | FIFE
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State | WA
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Zip | 98424-2647
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Country | US
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Telephone | 253-922-6522
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Fax | 253-922-6955
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00005499
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60271192
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License Number State | WA
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