Provider Demographics
NPI:1295301489
Name:HALSEMA, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:HALSEMA
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:PO BOX 241224
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524
Mailing Address - Country:US
Mailing Address - Phone:907-302-9164
Mailing Address - Fax:209-759-2653
Practice Address - Street 1:3105 LAKE SHORE DRIVE
Practice Address - Street 2:SUITE 4-101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517
Practice Address - Country:US
Practice Address - Phone:907-302-9164
Practice Address - Fax:209-759-2653
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
AKRBT-21-172924106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKN.AOtherN.A