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General NPI Number Information
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NPI Number | 1922925080
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Entity Type | Individual
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Provider Name | MICHAEL ERNEST OFALLON II
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Gender | Male
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 922 S J ST
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City | TACOMA
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State | WA
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Zip | 98405-4110
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Country | US
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Telephone | 253-356-6500
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Fax | 253-275-5450
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Provider Business Mailing Address
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Address Line | 919 S 9TH ST
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City | TACOMA
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State | WA
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Zip | 98405-4520
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Country | US
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Telephone | 253-356-6500
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Fax | 253-275-5450
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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 | CDPT.CO.70104503
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License Number State | WA
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