Provider Demographics
NPI:1982006698
Name:HILLIARD, TRICIA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 28TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-4004
Mailing Address - Country:US
Mailing Address - Phone:425-686-9509
Mailing Address - Fax:
Practice Address - Street 1:22605 SE 56TH ST STE 150
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5212
Practice Address - Country:US
Practice Address - Phone:425-686-9509
Practice Address - Fax:425-686-7260
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60815326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health