1972168029 NPI number — SASHA ANN TSURNOS LMSW, PSPIII, CDCS

Table of content: SASHA ANN TSURNOS LMSW, PSPIII, CDCS (NPI 1972168029)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972168029 NPI number — SASHA ANN TSURNOS LMSW, PSPIII, CDCS

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
TSURNOS

Provider First Name:
SASHA

Provider Middle Name:
ANN

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
LMSW, PSPIII, CDCS

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:
1972168029

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
03/15/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 W SANDVIK DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
WASILLA

Provider Business Mailing Address State Name:
AK

Provider Business Mailing Address Postal Code:
99623-0504

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
650-278-6511

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N. WILLOW ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
WASILLA

Provider Business Practice Location Address State Name:
AK

Provider Business Practice Location Address Postal Code:
99654

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
650-278-6511

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
05/03/2019

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 101YM0800X , with the licence number: 207552 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .