Provider Demographics
NPI:1508372236
Name:TATIANA DAUGHTREY LLC
Entity Type:Organization
Organization Name:TATIANA DAUGHTREY LLC
Other - Org Name:NORTH STAR WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHTREY COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, IBCLC, PMH-C
Authorized Official - Phone:480-788-2898
Mailing Address - Street 1:6 E PALO VERDE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1020
Mailing Address - Country:US
Mailing Address - Phone:480-788-2898
Mailing Address - Fax:
Practice Address - Street 1:6 E PALO VERDE ST STE 5
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1020
Practice Address - Country:US
Practice Address - Phone:480-788-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty