Provider Demographics
NPI:1548213069
Name:TINGLEY, BRIAN R (MS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:TINGLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2461
Mailing Address - Country:US
Mailing Address - Phone:253-752-1860
Mailing Address - Fax:253-752-1890
Practice Address - Street 1:1919 N PEARL ST
Practice Address - Street 2:SUITE C-1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2461
Practice Address - Country:US
Practice Address - Phone:253-752-1860
Practice Address - Fax:253-752-1890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist