Provider Demographics
NPI:1386611606
Name:VAN HOOMISSEN, MONICA M (PSYD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:VAN HOOMISSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S UNION AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1954
Mailing Address - Country:US
Mailing Address - Phone:253-761-0901
Mailing Address - Fax:253-761-1543
Practice Address - Street 1:1530 S UNION AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1954
Practice Address - Country:US
Practice Address - Phone:253-761-0901
Practice Address - Fax:253-761-1543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002581103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent