Provider Demographics
NPI:1437457397
Name:EARLY, JOANN (COUNSELING PSYCHOLOG)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:EARLY
Suffix:
Gender:F
Credentials:COUNSELING PSYCHOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RD AVE BLDG 2008B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-967-1445
Mailing Address - Fax:
Practice Address - Street 1:3 RD AVE BLDG 2008B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60177163101YA0400X
WAMG60185637101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)