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General NPI Number Information
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NPI Number | 1790491314
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Entity Type | Individual
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Provider Name | ISAAC MOKUA ROBERTS
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Gender | Male
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 737 FAWCETT AVE
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City | TACOMA
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State | WA
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Zip | 98402-5503
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Country | US
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Telephone | 253-396-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 2724 TIMBER DR SE
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City | OLYMPIA
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State | WA
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Zip | 98513-4232
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Country | US
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Telephone | 360-791-0187
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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