Provider Demographics
NPI:1316277049
Name:PICKETT, CAROLE RUTH (MA)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:RUTH
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MA
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 918
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-0918
Mailing Address - Country:US
Mailing Address - Phone:253-222-4670
Mailing Address - Fax:
Practice Address - Street 1:16414 92ND ST KPN
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-0918
Practice Address - Country:US
Practice Address - Phone:253-222-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00022838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health