Provider Demographics
NPI:1336897883
Name:THAI, MY THUC (LICSW)
Entity Type:Individual
Prefix:
First Name:MY
Middle Name:THUC
Last Name:THAI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 62ND ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8378
Mailing Address - Country:US
Mailing Address - Phone:253-268-8522
Mailing Address - Fax:
Practice Address - Street 1:310 3RD AVE NE STE 109
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3346
Practice Address - Country:US
Practice Address - Phone:425-659-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611217941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical