Provider Demographics
NPI:1114322088
Name:VANDERPOOL, MORGAN (LICSW, E-RYT)
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:LICSW, E-RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5861
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0861
Mailing Address - Country:US
Mailing Address - Phone:253-697-0190
Mailing Address - Fax:
Practice Address - Street 1:1011 S L ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4002
Practice Address - Country:US
Practice Address - Phone:253-697-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWI.LW.606505251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical