Provider Demographics
NPI:1750025052
Name:TAGALOA, TUTU
Entity type:Individual
Prefix:
First Name:TUTU
Middle Name:
Last Name:TAGALOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N KLEVIN ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1430
Mailing Address - Country:US
Mailing Address - Phone:907-825-2250
Mailing Address - Fax:907-272-4666
Practice Address - Street 1:1021 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-6102
Practice Address - Country:US
Practice Address - Phone:907-277-1731
Practice Address - Fax:907-272-4666
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health