Provider Demographics
NPI:1669282513
Name:TUSHAR, KELSEY TIERNEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:TIERNEY
Last Name:TUSHAR
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 1:415 1ST AVE N UNIT 9541
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4592
Mailing Address - Country:US
Mailing Address - Phone:206-535-1787
Mailing Address - Fax:
Practice Address - Street 1:415 1ST AVE N UNIT 9541
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4592
Practice Address - Country:US
Practice Address - Phone:206-535-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60567460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health