Provider Demographics
NPI:1295311413
Name:SIMBULAN, TAYA RENEE (CBT)
Entity type:Individual
Prefix:
First Name:TAYA
Middle Name:RENEE
Last Name:SIMBULAN
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NE BYERLY DR
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-9396
Mailing Address - Country:US
Mailing Address - Phone:831-234-9102
Mailing Address - Fax:
Practice Address - Street 1:7282 STINSON AVE STE B
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-4930
Practice Address - Country:US
Practice Address - Phone:253-858-5846
Practice Address - Fax:253-858-4063
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician