Provider Demographics
NPI:1225870652
Name:ROYAL, TALIA MOZELLE (LICSWA)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:MOZELLE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 149TH STREET CT S # B
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DRIVE SW
Practice Address - Street 2:MAILSTOP A-122, BLDG. 148
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493
Practice Address - Country:US
Practice Address - Phone:253-905-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC615563071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical