Tracey L Mullian, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW00009447 Issued in WA

Practice address

13823 197TH Ave E
Bonney Lake, WA 98391-5234

Phone

(253) 304-7701

NPI assigned

Jan 20, 2010

Last updated

Sep 16, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tracey L Goncalves Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1053642645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13823 197TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915234",
            "telephone_number": "253-304-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13823 197TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915234",
            "telephone_number": "253-304-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLIAN",
        "first_name": "TRACEY",
        "middle_name": "L",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-20",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00009447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "GONCALVES",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.