Provider Demographics
NPI:1982045217
Name:KANG, IRERI (LMFT)
Entity Type:Individual
Prefix:
First Name:IRERI
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:IRERI
Other - Middle Name:
Other - Last Name:VILLAGOMEZ-MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFTA
Mailing Address - Street 1:1011 E MAIN STE 103
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6768
Mailing Address - Country:US
Mailing Address - Phone:253-720-0386
Mailing Address - Fax:
Practice Address - Street 1:1011 E MAIN STE 103
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6768
Practice Address - Country:US
Practice Address - Phone:253-720-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist