Provider Demographics
NPI:1477733277
Name:SABO, MICHAEL J (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:SABO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1340
Mailing Address - Country:US
Mailing Address - Phone:253-627-4735
Mailing Address - Fax:
Practice Address - Street 1:514 S 13TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1908
Practice Address - Country:US
Practice Address - Phone:253-396-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003755101YM0800X
WALP00053714164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse