Provider Demographics
NPI:1730923392
Name:THOMASSON, ANTHONY TAZ
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TAZ
Last Name:THOMASSON
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 1:4716 38TH AVE S APT 502
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5573
Mailing Address - Country:US
Mailing Address - Phone:209-244-8295
Mailing Address - Fax:
Practice Address - Street 1:2100 24TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4637
Practice Address - Country:US
Practice Address - Phone:206-382-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health