Provider Demographics
NPI:1851626022
Name:TSAGALAKIS, TOM (MFT)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:TSAGALAKIS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NE 72ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5456
Mailing Address - Country:US
Mailing Address - Phone:206-522-6958
Mailing Address - Fax:
Practice Address - Street 1:402 NE 72ND ST STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5456
Practice Address - Country:US
Practice Address - Phone:206-522-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00000865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist