Provider Demographics
NPI:1417394438
Name:TACHELL, CARLI
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:TACHELL
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 1:3500 NW BUCKLIN HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8503
Mailing Address - Country:US
Mailing Address - Phone:360-337-2222
Mailing Address - Fax:360-850-0211
Practice Address - Street 1:3500 NW BUCKLIN HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8503
Practice Address - Country:US
Practice Address - Phone:360-337-2222
Practice Address - Fax:360-850-0211
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60362942101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor