1386898773 NPI number — DR. TAISSIA A CHATILO PSYD; MA; MPSY

Table of content: DR. TAISSIA A CHATILO PSYD; MA; MPSY (NPI 1386898773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386898773 NPI number — DR. TAISSIA A CHATILO PSYD; MA; MPSY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHATILO
Provider First Name:
TAISSIA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD; MA; MPSY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386898773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 292
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOHOMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98291-0292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-568-8737
Provider Business Mailing Address Fax Number:
360-568-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22600 96TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98020-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-546-6390
Provider Business Practice Location Address Fax Number:
360-568-1654
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00009033 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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