Provider Demographics
NPI:1073089199
Name:SCARBERRY, PAUL (LMHC-A, SUDP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SCARBERRY
Suffix:
Gender:M
Credentials:LMHC-A, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:ELBE
Mailing Address - State:WA
Mailing Address - Zip Code:98330-0382
Mailing Address - Country:US
Mailing Address - Phone:253-878-0536
Mailing Address - Fax:
Practice Address - Street 1:201 160TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8508
Practice Address - Country:US
Practice Address - Phone:253-904-6038
Practice Address - Fax:253-409-2622
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61300281101YA0400X
WAMC61508522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty