Provider Demographics
NPI:1245411685
Name:MULLIGAN, PHOEBE (LICSW)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 N. WESTGATE BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-460-7248
Mailing Address - Fax:
Practice Address - Street 1:6004 WESTGATE BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2503
Practice Address - Country:US
Practice Address - Phone:253-460-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601702191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical