Provider Demographics
NPI:1255835823
Name:MATTPAL PLLC
Entity type:Organization
Organization Name:MATTPAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-209-2661
Mailing Address - Street 1:2412 N 30TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6322
Mailing Address - Country:US
Mailing Address - Phone:253-209-2661
Mailing Address - Fax:
Practice Address - Street 1:2412 N 30TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6322
Practice Address - Country:US
Practice Address - Phone:253-209-2661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty