Provider Demographics
NPI:1649483009
Name:TJOSSEM, DONALD R (MS, MAC, SAP, CDP)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:TJOSSEM
Suffix:
Gender:M
Credentials:MS, MAC, SAP, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8903 KEY PENINSULA HWY N
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-9326
Mailing Address - Country:US
Mailing Address - Phone:253-884-4860
Mailing Address - Fax:253-830-0174
Practice Address - Street 1:8903 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9326
Practice Address - Country:US
Practice Address - Phone:253-884-4860
Practice Address - Fax:253-830-0174
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00039575101Y00000X
WACPOOOO4019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)