Provider Demographics
NPI:1609575372
Name:PICKELL, ANNABETH LYNN
Entity Type:Individual
Prefix:
First Name:ANNABETH
Middle Name:LYNN
Last Name:PICKELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 16TH ST E APT R202
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3407
Mailing Address - Country:US
Mailing Address - Phone:805-825-9769
Mailing Address - Fax:
Practice Address - Street 1:33309 1ST WAY S STE 100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6260
Practice Address - Country:US
Practice Address - Phone:253-517-5290
Practice Address - Fax:206-238-9450
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61372523106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician