Provider Demographics
NPI:1740587930
Name:TASSIN, MICHAEL WAYNE JR (LMFT, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:TASSIN
Suffix:JR
Gender:M
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 MALIBU DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1376
Mailing Address - Country:US
Mailing Address - Phone:360-742-7187
Mailing Address - Fax:
Practice Address - Street 1:90 LOUIS PRIMA DR STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5958
Practice Address - Country:US
Practice Address - Phone:360-742-7187
Practice Address - Fax:360-890-4099
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60340894101YM0800X
WALF60600292106H00000X
LA1334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health