Provider Demographics
NPI:1942625587
Name:TILSEN, BECKA (MA)
Entity Type:Individual
Prefix:
First Name:BECKA
Middle Name:
Last Name:TILSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 15TH AVE S APT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4280
Mailing Address - Country:US
Mailing Address - Phone:206-913-8131
Mailing Address - Fax:
Practice Address - Street 1:2021 15TH AVE S APT 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4280
Practice Address - Country:US
Practice Address - Phone:206-913-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60229575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health