Provider Demographics
NPI:1477256402
Name:WINSTEAD, TANIA E
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:E
Last Name:WINSTEAD
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 1:26812 118TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338
Mailing Address - Country:US
Mailing Address - Phone:844-623-9675
Mailing Address - Fax:888-977-1564
Practice Address - Street 1:26812 118TH AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338
Practice Address - Country:US
Practice Address - Phone:844-623-9675
Practice Address - Fax:888-977-1564
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
WAMC61522573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program