Provider Demographics
NPI:1073012084
Name:O'BLENNESS, TENNILLE SUZANNE
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:SUZANNE
Last Name:O'BLENNESS
Suffix:
Gender:F
Credentials:
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 4627
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-0627
Mailing Address - Country:US
Mailing Address - Phone:509-624-1244
Mailing Address - Fax:509-624-6240
Practice Address - Street 1:2308 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5810
Practice Address - Country:US
Practice Address - Phone:509-624-1244
Practice Address - Fax:509-624-6240
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60313150101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)