Provider Demographics
NPI:1316544174
Name:TIKUNOFF, STEVEN PAUL JR (CO61095300)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PAUL
Last Name:TIKUNOFF
Suffix:JR
Gender:M
Credentials:CO61095300
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:P
Other - Last Name:TIKUNOFF
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:CO61095300
Mailing Address - Street 1:2817 WHEATON WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3440
Mailing Address - Country:US
Mailing Address - Phone:360-373-0155
Mailing Address - Fax:
Practice Address - Street 1:2817 WHEATON WAY STE 205
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3440
Practice Address - Country:US
Practice Address - Phone:360-373-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61095300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)