Provider Demographics
NPI:1811520844
Name:TOLENOA, MARK TULENSRU
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:TULENSRU
Last Name:TOLENOA
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 1:5633 123RD PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-6252
Mailing Address - Country:US
Mailing Address - Phone:315-254-4382
Mailing Address - Fax:
Practice Address - Street 1:851 POPLAR PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2827
Practice Address - Country:US
Practice Address - Phone:206-322-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health