Provider Demographics
NPI:1245590363
Name:WASHA, TIFFANY M (LMHC #LH60460259)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:WASHA
Suffix:
Gender:F
Credentials:LMHC #LH60460259
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MA
Mailing Address - Street 1:614 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2606
Mailing Address - Country:US
Mailing Address - Phone:360-856-3054
Mailing Address - Fax:
Practice Address - Street 1:614 PETERSON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2606
Practice Address - Country:US
Practice Address - Phone:360-856-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60202028101YM0800X
MDLC6706101YP2500X
WALH60460259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional