Individual
MIGUEL A IRACHETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE, TACOMA, WA 98431-1898
(815) 546-6397
Mailing address
PSC 819 BOX 3226, FPO, AE 09645-0033
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.009922
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/16/2012
Last updated
03/18/2021
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