Provider Demographics
NPI:1477268399
Name:DUNLAP, TISHINA LORRAYNE (SUDPT)
Entity Type:Individual
Prefix:MRS
First Name:TISHINA
Middle Name:LORRAYNE
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-0252
Mailing Address - Country:US
Mailing Address - Phone:541-519-6181
Mailing Address - Fax:
Practice Address - Street 1:2280 STATE ROUTE 821
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-8302
Practice Address - Country:US
Practice Address - Phone:509-457-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61354420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)