Provider Demographics
NPI:1265161517
Name:TIZON, DYLAN OLIVIA
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:OLIVIA
Last Name:TIZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19234 15TH AVE NW APT B
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2785
Mailing Address - Country:US
Mailing Address - Phone:206-909-5215
Mailing Address - Fax:
Practice Address - Street 1:7500 212TH ST SW STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7617
Practice Address - Country:US
Practice Address - Phone:425-977-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor