Provider Demographics
NPI:1063142149
Name:ROYSE, MERRILLEE (LICSW)
Entity type:Individual
Prefix:
First Name:MERRILLEE
Middle Name:
Last Name:ROYSE
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 1:14114 8TH AVENUE CT S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-3346
Mailing Address - Country:US
Mailing Address - Phone:253-219-5306
Mailing Address - Fax:
Practice Address - Street 1:14114 8TH AVENUE CT S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-3346
Practice Address - Country:US
Practice Address - Phone:253-219-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611514791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical