Provider Demographics
NPI:1982288106
Name:TINNIN, ANGELIA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:CHRISTINE
Last Name:TINNIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4446
Mailing Address - Country:US
Mailing Address - Phone:509-528-6374
Mailing Address - Fax:
Practice Address - Street 1:7 W 49TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-4446
Practice Address - Country:US
Practice Address - Phone:509-528-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61137920103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst