| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MYRNA JUDITH KAIPOV | 1265102255 | 2021-09-20 |
Myrna Judith Kaipov is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1265102255. Registration indicates Myrna Judith Kaipov is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor, Behavioral Health & Social Service Providers) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care) Access to Mental Health/Behavioral Health Providers (Behavioral Health & Social Service Providers, Social Worker) (Behavioral Health & Social Service Providers, Social Worker) (Social Worker, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker, Behavioral Health & Social Service Providers)
| Entity Type | Individual |
| Provider Name | Myrna Judith Kaipov |
| Other Provider Name | Myrna Judith Dalakishvili |
| Practice Office Address | 3857 MARTIN WAY E OLYMPIA, WA US |
| Practice Office Telephone | 3607047140 |
| Mailing Address | 4628 DURHAM ST SE LACEY, WA 985032193 US |
| Business Telephone | 9152384662 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 343 E Main St | Stockton, CA 952022905 | 5106192597 |
| Work email [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 101Y00000X | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Counselor Behavioral Health & Social Service Providers Counselor Counselor Behavioral Health/Substance Abuse/Psychiatry Counselor Behavioral Health & Social Service Providers |
WA |
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | |
| 104100000X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker Behavioral Health/Substance Abuse/Psychiatry Social Worker Behavioral Health & Social Service Providers | SA61410542
WA |