Provider Demographics
NPI:1457925844
Name:HARRIS, TANISHA (LICSW)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15250 32ND AVE S # 69581
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-9996
Mailing Address - Country:US
Mailing Address - Phone:360-209-4203
Mailing Address - Fax:
Practice Address - Street 1:15250 32ND AVE S # 69581
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-9996
Practice Address - Country:US
Practice Address - Phone:360-209-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609853841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical