Provider Demographics
NPI:1346921731
Name:TUNG, OLIVIA MADISON (CBT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MADISON
Last Name:TUNG
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 S 370TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7587
Mailing Address - Country:US
Mailing Address - Phone:206-257-8983
Mailing Address - Fax:
Practice Address - Street 1:1641 S 370TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7587
Practice Address - Country:US
Practice Address - Phone:206-257-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61338893106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician