Provider Demographics
NPI:1659463644
Name:BAKKANE, TARYN NICOLE (BA)
Entity Type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:NICOLE
Last Name:BAKKANE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:TARYN
Other - Middle Name:NICOLE
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4807 196TH ST SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6430
Mailing Address - Country:US
Mailing Address - Phone:425-744-1216
Mailing Address - Fax:
Practice Address - Street 1:4807 196TH ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6430
Practice Address - Country:US
Practice Address - Phone:425-744-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00054432101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor