Provider Demographics
NPI:1780981753
Name:PAULL, MYRA J (LICSW)
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:J
Last Name:PAULL
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 1:5426 138TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-9112
Mailing Address - Country:US
Mailing Address - Phone:253-589-5334
Mailing Address - Fax:253-584-1496
Practice Address - Street 1:8103 STEILACOOM BLVD SW
Practice Address - Street 2:PMB 274
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6154
Practice Address - Country:US
Practice Address - Phone:253-589-5334
Practice Address - Fax:253-584-1496
Is Sole Proprietor?:No
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000087381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical