Provider Demographics
NPI:1588062475
Name:MYRICK, JOSEPH KIM (LICSWA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:KIM
Last Name:MYRICK
Suffix:
Gender:M
Credentials:LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5005 PACIFIC HWY E STE 20
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2647
Mailing Address - Country:US
Mailing Address - Phone:253-922-6522
Mailing Address - Fax:253-922-6955
Practice Address - Street 1:325 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-697-8400
Practice Address - Fax:253-697-3730
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005499101YA0400X
WASC602711921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)