Provider Demographics
NPI:1386211894
Name:TFD CARES/BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:TFD CARES/BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CSR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-591-2044
Mailing Address - Street 1:901 FAWCETT AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5605
Mailing Address - Country:US
Mailing Address - Phone:253-591-5737
Mailing Address - Fax:253-591-5737
Practice Address - Street 1:901 FAWCETT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5605
Practice Address - Country:US
Practice Address - Phone:253-591-5737
Practice Address - Fax:253-591-5746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF TACOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001002016Medicaid
WA0056986OtherLABOR & INDUSTRIES
WA9032715Medicaid
WA590007108OtherUHC